Case:Normy

Normy:Feline
Male Domestic Shorthair
http://
Born	Apr-1993
Dx	May-2006
Oral meds	:
Regulated	Oct-2006
Regulated between 90 and 200
Remission	Not-yet
Insulin	BCP PZI

Normy: Age: 13 Birthdate: 4/11/93

I have 2 Cats: Normy is 14 pounds, very inactive. Rocky, my non-diabetic nutso cat, is 12 pounds and 7 years old. I suspect Normy has arthritis, but it has never been diagnosed.

In June 06, I noticed that Normy was drinking a bit more than usual; sneezing a bit more; lost meow for a few days.

A few weeks later, he was sleeping a lot more and cried when I picked him up. He also began laying down very slowly, almost like he was severely arthritic or in pain. He also began moaning slightly after eating any type of food. One day I also noticed that the litter box was really full and found Normy with cement boots.

Normy has possible neuropathy. At diagnosis, I noticed he limped on right back leg only. Gave methyl B12 3mg BID. Still favoring a limp on his right back leg as of 9/8. Better in later Sept/Oct. Full muscle tone recovered in October. Reduced B12 in December 2006 to 1.5 mg BID, but appetite got really poor and had trouble climbing stairs. In 12/06, put back on 3mg BID. Appetite and attitude picked up. Haven't noticed any limping since then.

Had 2 different UTIs: Enterococcus sp. at diagnosis that didn't go away until he had 2 courses of ABs (CEFA andClavamox). EColi required 2 long courses of AB (Clavamox) as well. Once the UTIs cleared up, Normy's #s stayed in the 100s, with an occassional 200. The only way to get bacteria out of Normy's bladder and rid of the UTI was to practice Tight Regulation with aggressive dosing.

DX DIABETIC: 5/27/06 BG 436 under very stressful circumstances. No urine glucose reading at that time. Reading FDMB since that date.

Tried modifying diet first, but with no success. Able to get rid of dry food, but only eats supplemented cooked chicken.

Normy back to vet on 6/27/06, but due to infection, the BG was still in the 300s+.

6/27/06 BG 517 under very stressful circumstances. Normy was also drooling at this visit. Diagnosed with UTI; CEFA DROPS for 10 days; Last dose: 7/11/06

INITIAL BLOODWORK:

FRUC: 518 According to bloodwork on 6/24/06, liver disease secondary to diabetes.

5/27 (HIGH CARB DIET BLOOD VALUES): Normy / Normal NA 149 148-159 K 3.9 3.5-5.5 CL 115 114-127 T4 1.8 0.8-4.0 CHOL 137 95-200 ALTNEW 67H 7-60 <======== AMYL 1188 600-1600 ALPNEW 47H 10-42 <======== TBILI 0.2 0.1-0.5 GLU 436H 70-160 <======== PHOS 3.5 2.6-5.7 TPROT 7.9 6.5-8.4 BUN 29 10-40 CREAT 1.5 0.4-2.0 CA 9.4 8.2-10.6 DBILI 0.2 0.0-0.3 ALB 3.0 2.2-3.2 Hematology Profile: Mostly normal. MCV was 37.3L, normal 39-52 Mild Microcytosis. MCHC was 38.1H, normal 30-37. Diagnostic Considerations: Suspect iron definciency.

No Urinalysis. Vet lost sample while taking blood. Tried to get urine sample at home after visit, but was unsuccessful. Probably had infection at this time, but wasn't medicated for it.

6/27/06 (LOW CARB DIET BLOODWORK): Normy / Normal NA 149 148-159 K 3.6 3.5-5.5 CL 113L 114-127 CHOL 137 95-200 ALTNEW 121H 7-60 <= LIVER PROBLEMS SECONDARY TO DIABETES

AMYL 1111 600-1600 TBILI 0.2 0.1-0.5 GLU 517H 70-160 No wonder! Normy was drooling waiting over an hour for his appt.! PHOS 3.5 2.6-5.7 TPROT 7.6 6.5-8.4 BUN 40 10-40 CREAT 1.4 0.4-2.0 CA 9.4 8.2-10.6 DBILI 0.3 0.0-0.3 ALB 2.5 2.2-3.2 Hematology Profile: Mostly normal. MCV was 37.2L, normal 39-52 Mild Microcytosis. MCHC was 38.5H, normal 30-37. Diagnostic Considerations: Suspect iron definciency.

Urinalysis indicated infection. Not sure if culture was done.

Never any keytones. Saw some blood in urine while on CEFA and Clavamox due to infection.

WEIGHT: 14.4lbs. I think his highest weight was about 16pounds, but he is a big cat with large paws. Not sure what his ideal weight is, since most of his weight used to be muscle and abdominal fat.

FOOD: Previously fed Hills Science Diet Light (old vet advise for weight loss;helped him maintain only) mixed with cooked chicken topper for practically his whole life. Most recent snacks were 10 pieces of Friskies Dental Diet.

Since diagnosis, weaned off dry and onto chicken only.

UNFORTUNATELY, NORMY WILL NOT EAT ANY CANNED CAT FOOD! I have tried almost all brands, but the smell makes him nauseous. He will eat a tiny bit of raw (fresh or freeze dried), but then he gets really bad stomach aches as well. Never tested for pancreatitis, but has very bad reaction to fats. If given any fats, including butter, red meat, turkey, etc, exhibits signs of abdominal discomfort and high BG for many days.

I have tried syringe feeding, pureeing, mixing every which way, but he won't eat wet. Even the all meat Wysong and Avoderm has an offensive odor to it. Won't eat fish....another cat who hates fish!

Had to resort to a cooked chicken diet with added supplements so he doesn't get stressed out. Have added calcium, Feline Performance multi-vitamin, taurine, and B-12 (3 mg BID) to his meals. Tried cranberry extract for the UTI problem, but only temporarily. Also currently gets 1/3 Cosequin capsule BID for arthritis and to strengthen bladder. Tried milk thistle on/off for several months. SAM-E only made BG stay in the 200s, also he seemed to get a mental boost from it.

GLUCOMETER: ACCU-CHEK ADVANTAGE (Abandoned on 8/28-too much blood) Used FREESTYLE FLASH (possibly too low compared to Lab readings), and GlucoPet (way too high). As of 10/25/06, FREESTYLE FREEDOM only, with OTU as a backup.

TRIED VETSULIN FIRST AS REQUIRED BY VET VETSULIN #s (Rx 2 UNITS-Originally wanted 3 based on the wt!):

7/2| AMPS: 331 Dose: 2 UNITS +4: 72 - Fed handful of EVO because I had no idea what his peak was. +12: 130 NO PM INSULIN +14: 3cc Cefa for UTI via syringe. Hated it! +17: 244

7/3 AMPS: 319 DOSE: 2 UNITS +4.5: 180 PMPS: 351 DOSE: 2 UNITs

7/4 AMPS: 371 Dose: 1 UNIT +4: 286 PMPS: 316 DOSE: 2 UNITS +4: 71

7/5 AMPS: 364 DOSE: 1 1/2 UNITS +4: 159 +7: 123 PMPS: 324

7/6 AMPS: 326 DOSE: 1 1/2 UNITS +2: 292 +5: 198 +6: 218 PMPS: 293 (+11) +3: 169 +4: 137 +5: 145

7/7 AMPS: 399 (+13) DOSE: 1 1/2 UNITS +4.5: 208 +6: 227 PMPS: 290 (+11) +3: 184 +6: 148

7/8 AMPS: 321 DOSE: 1 1/2 UNITS +4: 227 +5: 173 +6: 146 +7: 220 +8.25: 277 +10: 348 PMPS: 428 DOSE: 1 1/4 UNITS +2: 342 +4: 155 +6: 194

7/9 AMPS: 366 DOSE: 1 1/4 UNITS +4.75: 182 PMPS: 280

7/10 AMPS: 346 DOSE: 1 1/4 UNITS +6: 276 +7: 271 PMPS: 391 ? IS HE REBOUNDING DOSE: 1 UNIT +3: 300 +4: 242 +5.75: 283

7/11 AMPS: 402 DOSE 1 1/2 UNITS +5.75: 197 PMPS: 359 DOSE: 1 1/2 UNITS +4: 200 LAST DOSE CEFA GIVEN AT 9:30PM +5.75: 284

7/12 (OFF ALL MEDS) AMPS: 355 (+12.5) DOSE: 1 1/2 UNITS +4: 225 +7.5 172 PMPS: 318 (+12.5) DOSE: Increased dose to 1.8 UNITS using U100 syringe +4: 126 +4.5: 141 +5: 127 +5.5: 112 +6: 125

7/13 AMPS: 320 (Tested +11.5) DOSE: 1.8 UNITS - SAME DOSE, SIMILAR PRESHOT, DIFFERENT DROPS (AM vs PM) +4: 263 +6.5: 253 PMPS: 342 (+11.5) DOSE: REDUCED TO 1.4 UNITS +4: 204 +5.5: 222

7/14 AMPS: 385 (+10.5) DOSE: .8 UNITS +4: 283 +5: 298 +7: 307 +11.5: 338 PMPS 414 (45 min after food) DOSE: 1 UNIT +2: 340 +5: 260 +6: 344

7/15 AMPS: 399 DOSE: 1 UNIT +4: 233 +5: 192 +6: 168 PMPS: 313 (+11) DOSE: 1 UNIT +2: 314 +4: 261 +6: 308

7/16 AMPS: 321 (+12.5) DOSE: 1.2 UNITS +2.5: 326 +4: 233 +5.5: 255 +8: 247 PMPS: 294 (+11.5) DOSE: .6 UNITS +2: 216 +4: 354 ? +5: 278 +10: 343

7/17 AMPS: 406 (+12.5) DOSE: .4 UNITS +2: 293 +5: 270 PMPS: 374 (+11) DOSE: 1 UNIT +3: 297 +5: 289

7/18 AMPS: 483 (+13) (15 Minutes After food) (NORMY\'S EARS HURT) DOSE: 1 UNIT PMPS: 354 (+11) +4: 201

7/19 (NORMY FELT CRAPPY TODAY & IT SHOWS) AMPS: 347 DOSE: 1 UNIT +6: 260 PMPS: 469 (+11) DOSE: .8 UNITS +2: 326 +4: 255 +6: 353

7/20 AMPS: 325 (+12.5) DOSE: 1 UNIT +2: 286 +4: 209 +6: 236 PMPS: 335 (+11) +2: 291 +4: 202

NOTES: VETSULIN is driving me insane. The highs and lows can't be good for Normy, and they are causing me more worry than anything. Normy feels crappier on higher doses and will go lie down after getting shots in excess of 1 unit. Does that mean he's getting too much insulin? The swings are killing him too. He cries for food whenever it's dropping or raising him too quickly. He also has dopey periods when he sits there and closes his eyes on and off, yet his glucose is not even near a hypo number. He also looks around the room like his head is spinning during the drops. I can't stand to watch him suffer, so I usually feed him a little something. No matter what dose I try, he doesn't show any signs of excess drinking (all extraneous drinking stopped after he was switched to low carb), polyuria (4X a day which coincides with # of meal times and pee balls are slightly larger than those of non-diabetic). He only seems really hungry when he is dropping quickly from higher numbers.

7/20: His brother Rocky has started to beat up on him again, and Normy has begun stalking Dusty(mini poodle brother), so that's pretty normal. This is a sign of feeling better.

7/21

AMPS: 321 (+12.5) DOSE: 1 UNIT +5: 277 PMPS: 354 +2: 263 +4: 241

7/22 AMPS: 335 DOSE: 1.4 UNIT +2: 324 +3: 231 +4: 223 +5: 207 PMPS: 300 (+10.5) +2: 266 +3: 196 +5: 190

7/23 AMPS: 521 - REBOUND? DOSE: 1 UNIT +4.5: 270 +8.5: 275 PMPS: 314 (+10.5) +2: 304 +9: 437 - REBOUND AGAIN?

7/24 Added some milk thistle today. Had bad diarrhea in PM. Pee-you! AMPS: 361 (+14) DOSE: 1.2 UNITS +4: 162/200 200 was after 6 pokes. Sorry Normy! +5: 192 PMPS: 364 (+11) DOSE: 1 UNIT +4: 265

7/25 AMPS: 332 DOSE: 1.2 UNITS +4: 229 PMPS: 324 (+11) DOSE: 1.2 UNITS +3.5: 254 +4.5: 280 +7.5: 265

7/26 AMPS: 288 (+11.5) DOSE: .8 UNITS +2.75: 275 +5.5: 329 PMPS: 391 (+11.25) DOSE: 1.2 UNITS +4: 236 +5: 205

7/27 AMPS: 353 (+11.75) DOSE: 1.2 UNITS PMPS: 460 (+11.5) DOSE: 1.2 UNITS +3: 366 +4.5: 270

7/28 AMPS: 360 DOSE: 1.2 UNITS +6.5: 343 PMPS: 343 (+11) DOSE: 1.2 UNITS +4: 243

7/29 AMPS: 434 DOSE: 1.4 UNITS +4: 293 +5: 261 +6: 255 +7: 239 +9.25:387 PMPS: --- (+10) DOSE: 1 UNIT FOUND SOME PUKE WITH CHICKEN/PIECE OF GRASS. NOT ENOUGH TO BE ENTIRE DINNER. DID REFEED SOME SINCE HE WAS LOOKING. +4: 246 +7: 277

7/30 AMPS: 494 (+13) IS THIS # FROM BELLY ACHE OR REBOUND. DOSE: .6 UNITS +3: 315 +4: 295

To date, I don't think Normy has an improved quality of life with this insulin. Sometimes, it seems to make him feel worse. I haven't seen the 100's since 7/24 with all my spotchecks. Does he have another infection or did the last one not go away? No blood in urine and urine glucose is higher when he has more insulin in him.

7/31 AMPS: 351 DOSE: 1 UNIT +4: 262 PMPS: 388 (+11) DOSE: 1.4 UNITS +2: 290 +4: 161 +5: 210 +6: 251

8/1 AMPS: 337 - Yay! No rebound on higher dose. DOSE: 1.4 UNITS +2.5: 267 - Added extra food. Want to recreate last night. +4: 248 - Can't do it. Less exercise during day! Doesn't need more food. +6: 273 PMPS: 367 DOSE: 1.4 UNITS +2.5: 299 +4: 277 +4.5: 257 +5: 281

8/2 AMPS: 409 DOSE: 1.4 UNITS +2.5: 299 +4: 248 +6: 263 PMPS: 414 1hr after food 500 DOSE: 1.4 UNITS +3.75:221 +4: 187

8/3 AMPS: 415 DOSE: 1 UNIT +5: 267 +9.25:345 PMPS: 369 DOSE: 1.4 UNITS +4: 258 (food spike)

8/4 AMPS: 359 DOSE: 1.2 UNITS PMPS: 394 (+10.75) DOSE: 1.4 UNITS @ +11.75 +2: 318 +4: 245

8/5 AMPS: 370 DOSE: 1.4 UNITS +3: 365-VET 370-LAB +8: 375 +10: 288 PMPS: (+10.5) DOSE: 1.4 UNITS +3.5: 215 +4.5: 211

8/6 AMPS: 368 (+13) DOSE: 1.4 UNITS +3.75:258 +10: 367 PMPS: (+11) DOSE: 1.4 UNITS +4: 253 Showing UTI symptoms again. Blood in urine;in/out of litter; straining. Urine test confirms blood in urine and ph about 6.5. Gave water for pain.

8/7 AMPS: 329 DOSE: 1.4 UNITS +2: 400 +4: 223 +6: 216 Blood gone from urine. ph still above 5.0. Made vet appt. for 8/8. PMPS: 410 (+11) DOSE: 1.6 UNITS 1/2 hr later +3.75:214 +5: 207

Is the insuling losing effectiveness? Going on 22 days for bottle. Last time switched after 14 days.

8/8 AMPS: 350 DOSE: 1.6 UNITS 1/2 hr later +4.25:257 +6: 282 Blood gone; ph back to 5.0. Normy feeling better. Vet didn't want to see since feeling better. PMPS: 421 (+11) DOSE: 1.2 UNITS +2.75:271 +4: 225 +4.5: 251 +10.5:320

8/9 AMPS: 343 (+11.75) DOSE: 1.5 UNITS +4: 289 +6: 360 Normy's bladder is hurting him. No litterbox signs, but sitting slowly and general malaise. Howling/hiding. Take to vet on 8/10. PMPS: 444 (+11) DOSE: 1.2 UNITS +3.5: 161

8/10 AMPS: 404 DOSE: 1 UNIT +2: 348 VET F/T vet did C&S, U/A ; Xray. No stones. Tried to give CEFA again for suspect infection, but puked it up. Have to try new insulin. Not sure if Vetsulin has lost effectiveness.

READINGS WITH BCP PZI

==STARTED BCP PZI=

8/10 PMPS: 419 (+10.75) DOSE: .5 UNIT BCP PZI +2: 322 +4: 336 +6: 363

8/11 AMPS: 353 DOSE: 1 UNIT BCP PZI +2.25:325 +4: 327 +6: 340 Vet called: U/A +++bacteria and +++glucose. Questioning regulation methods after examing file on Normy. Stressed to keep him on 1 UNIT PZI for week to 10 days. Agreed. PMPS: Hard time testing. Feeling crappy and mean. DOSE: 1 UNIT PZI +0.5: 405 UTI really bad tonight. Couldn't test-in/out litterbox.

8/12 AMPS: 353 DOSE: 1 UNIT PZI +5.75:351 PMPS: 377 (+11) DOSE: 1 UNIT PZI - +1 +3.5: 305 Gave up on CEFA drops. Started Amox tablets in AM. Able to slip pill down throat with butter at 3pm/3am.

8/13 AMPS: 386 (+11.75) +5: 354 +6: 334 +7: 333 +8: 365 +9: 332 +10: 343 Is this a bad bottle or is it even working? Normy feels really crappy. High sugar plus UTI has really hit him hard. I have to increase to see if the insulin is any good. I heard this was a gentler insulin, but I can't believe no change after 3 days. PMPS: 343 (+10) DOSE: 1.5 UNITS PZI (+11) +2: 340 +4: 275 +6: 234 He's feeling a lot better on this dose so far. Meds probably kicked in too. (Hindsight: perhaps Normy is seeing overlap from AM)

8/14 AMPS: 327 DOSE: 1.5 UNITS PZI +4: 301 +6: 291 PMPS: 295 (+11) DOSE: 1.5 UNITS PZI +4: 268

8/15 AMPS: 301 (+11.75) DOSE: 1.5 UNITS PZI +2: 274 +5.5: 323 PMPS: 412 (+10.75) DOSE: 1 UNIT PZI +11.5 Dropped dose because thought rebound. Normy very sick today. Probably infection driving numbers. +0.75:349 +4: 311

8/16 AMPS: 293 (+12.25) DOSE: 1 UNIT PZI Culture back from vet. UTI will require Clavamox. Enterococcus spp. bacteria found. AMOX in AM, Clavamox in PM. Vet also said this could have been the original infection and never went away. Should have gotten culture-- then why didn\'t they suggest it? UGH! PMPS: 388 (+10.75) DOSE: 1.5 UNITS PZI (+11.5) +0.75:362 +3.75:317 +5: 292

8/17

AMPS: 355 DOSE: 1.5 UNITs PZI +6: 355 PMPS: 320 (+10.75) DOSE: 1.5 UNITS PZI +4.5: 245

8/18 AMPS: 394 DOSE: 1.5 UNITS PZI +6: 296 +11: 205 +12.5:180 Let's see where this goes. Going lower even with food. Duration? +13.5:159 +14.5:165 +15: 157 Several urine readings during day indicated no glucose. PMPS: 186 (+16) DOSE: .5 UNITS PZI - token dose to keep on schedule +0.5: 202 +2.75:272 +7.75:341 Back up. Overlap pushing higher or .5 not enough to sustain BG.

8/19 AMPS: 315 (+10) DOSE: 1.5 UNITS PZI +2: 311 +4: 360 Inverted curve. Too much w/ overlap or poop out on last dose? +6: 352 +8: 350 PMPS: 324 (+10) DOSE: 1.5 UNITS PZI UTI acting up again. Felt crappy. +2: 277/293 +3: 285

8/20 AMPS: 340 (+11.5) DOSE: 1 UNIT PZI - Normy looking crappy in AM. +4: 353 +6: 349 +11.25:343 AMPS: 352 (+12.25) 40 min after food DOSE: 1.5 UNITS PZI +4.75:308

8/21

AMPS: 352 (+11.5) DOSE: 1.6 UNITS PZI - trying U100 needle-more precise. +6: 329 +10.75:325 PMPS: 282 (+12.25) DOSE: 1.4 UNITS PZI - reduced dose +4: 159 +4.45:149

8/22 AMPS: 242 (+11) DOSE: 1.2 UNITS PZI - reduced dose +2: 276 +6: 258 PMPS: 352 (+10.75) DOSE: 1.6 UNITS PZI +4: 271

8/23 AMPS: 374 DOSE: 1.6 UNITS PZI +6.25: 299 PMPS: 405 (+11.5) after food DOSE: 1.6 UNITS PZI +4: 298 +6: 311 +9: 337

8/24 AMPS: 313 DOSE: 1.6 UNITS PZI +5.75: 337 +10.75:361 PMPS: DOSE: 1.6 UNITS PZI (+11.75) +4.25: 298

8/25 AMPS: 296 (+12) DOSE: 1.6 UNITS PZI +2.5: 318 +6: 302 PMPS: 453 (+10.5) Sick?Rebound? DOSE: 1.2 UNITS PZI +5: 315

8/26 AMPS: 326 DOSE: 1.2 UNITS PZI +5: 331 +9: 348 +11.5: 313 PMPS: 366 DOSE: 1.4 UNITS PZI +4: 321

8/27 AMPS: 372 (+11.25) DOSE: 1.4 UNITS PZI (+12) +5.5: 312 +8: 311 PMPS: 358 (+11.75) DOSE: 1.4 UNITS PZI

8/28 AMPS: 399 (+11.5) DOSE: 1.6 UNITS PZI +6: 295 +9: 258ff/308ACA - New meter. Sick of huge samples. PMPS: 254ff/322ACA DOSE: 1.6 UNITS PZI +4: 274ff

8/29 AMPS: 290ff/346ACA (+11.75) DOSE: 1.6 UNITS PZI +6: 269ff PMPS: AWAY DOSE: 1.4 UNITS PZI - HUBBY - Last Clavamox

8/30 AMPS: AWAY DOSE: 1.4 UNITS PZI - HUBBY +9: 362ff/406ACA +11: 284ff PMPS: 282ff (+12.5) DOSE: 1.4 UNITS PZI Got into dry dog food-not sure how much +1.5: 308ff +3.75: 338ff +5: 308ff

All readings ff (Freestyle Flash) unless otherwise indicated)

8/31 AMPS: 314 (+11) DOSE: 1.6 UNITS PZI +2: 303 +6: 291 +10.5: 276 PMPS: 349 ACA DOSE: 2 UNITS PZI +1.25: 275 +2.25: 256 +3.5: 252 +5: 276 +9.75: 277 This is not the drop I would have expected with 2 units. Technically, he's still in the 300s with the ACA meter. Problem with bottle, shot location, or dose? Order new bottle and change location to behind scruff.

9/1 AMPS: 304 (+11.5) DOSE: 1.6 UNITS PZI +6: 294 +11: 279 330ACA PMPS: 291 326ACA DOSE: 1.4 UNITS PZI - NEW BOTTLE +3.5: 214 +4.5: 206 +9.25: 288

9/2 AMPS: 286 (+11.25) DOSE: 1.4 UNITS PZI +2: VET VISIT FOR C&S/UA Recheck +3.75: 343 +6.5: 278 +9.5: 235 PMPS: 239 323 Glucopet (WOW! 100 pts higher than ff!) DOSE: 1.4 UNITS PZI +2.75: 273 +5.5: 276

9/3 AMPS: 319 DOSE: 1.4 UNITS PZI +3: 296 +5.75: 305 Starting to think that Normy is getting too much insulin. No big drop when increased to 2 units. Less glucose in urine when I reduced dose to 1.4. Even though infection is gone, still seems more lethargic. Seems to be dropping consistently after food. And have noticed an inverted curve when he should be hitting peak at 6+. Try reducing dose. PMPS: 327 (+11.75) DOSE: 1.2 UNITS PZI +1.75: 268 +5.25: 182/187/233 BETTER +8: 197

9/4 AMPS: 331 - thinking rebound again. Try reducing 25%. DOSE: 0.9 UNITS PZI (FAT 0.8) +1.75: 321 +5: 211 +8.25: 257 PMPS: 339 (+11) - rebound? Try reducing 25%. - Afterthought:nope. DOSE: 0.6 UNITS PZI +2: 309 Glucopet 409 +4: 253 +5.5: 313 GP 409 +9: 307

9/5 AMPS: 321 (+11.75) DOSE: 1 UNIT PZI +2.25: 289 +6: 276 PMPS: 292 (+11.75) - 1 hr post food DOSE: 1 UNIT PZI - ALSO GAVE 1 DROP OF METACAM FOR PAIN (BLADDER &/OR ARTHRITIS) +5: 275

9/6 AMPS: 286 (+11.75) DOSE: 1 UNIT PZI +5.75: 162 (not sure if full sample - couldn't get more blood) PMPS: 305 (+12.25) DOSE: 1 UNIT PZI +3.75: 209

9/7 AMPS: 312 (+11.5) DOSE: 1 UNIT PZI +6: 189 PMPS: 290 DOSE: 1 UNIT PZI +5.5: 312

9/8 AMPS: 306 (+11.5) DOSE: 0.8 UNITS PZI +6: 241 PMPS: 298 +11 B4 food DOSE: 0.8 UNITS PZI - GAVE 1 DROP METACAM IN FOOD +4.5: 254

9/9 AMPS: 295 (+11) DOSE: 1 UNIT PZI +4: 225 +5.5: 201 +6.5: 225 Culture back-Normy has E Coli now. Back on Clavamox for 2 weeks. Enterococcus gone. PMPS: 275 (+11.5) DOSE: 1 UNIT PZI

9/10 AMPS: 293 (+11.75) DOSE: 1 UNIT PZI +5.75: 254 PMPS: 275 (+11.5) Glucopet said 408 DOSE: 1 UNIT PZI +1: 340 ACA +4.75: 228

9/11 AMPS: 328 (+11.5) DOSE: 0.8 UNITS PZI +6: 317 PMPS: 283 (+10.75) DOSE: 1.2 UNITS PZI - GAVE 1 DROP METACAM IN FOOD +3: 250 +4.75: 239

9/12 AMPS: 279 (+11.75) DOSE: 1.2 UNITS PZI +2: 289 +6: 274 PMPS: 269 (+11.75) DOSE: 1.2 UNITS PZI +2: 220 +4: 128ff 173GP +5: 109 +5.5: 137 ABs starting to work, I think.

9/13 AMPS: 329 DOSE: 1 UNIT PZI +4: 224 +6: 222 Ate some of Dusty's dry before I could test him for shot. PMPS: 264 (+11) DOSE: 1.2 U PZI +4: 292

9/14 AMPS: 295 DOSE: 1.2 UNITS PZI +2: 280 +5.5: 242 PMPS: 272ff 346ACA (1 hour after food) DOSE: 1.2 U PZI +2.5: 237 +5.5: 234

9/15 AMPS: 330 (+11.5) huh?? DOSE: 1 UNIT PZI +6.25: 305 PMPS: 300 DOSE: 1 UNIT PZI +3.5: 248 +4.75: 245

9/16 AMPS: 262 DOSE: 1 UNIT PZI +4.25: 238 +6: 212 PMPS: 261 DOSE: 1 UNIT PZI +4.5: 156 +5.5: 181

9/17 AMPS: 257 DOSE: 1 UNIT PZI +4.25: 281 +5.5: 254 +10: 257 PMPS: 242 DOSE: 0.8 UNITS PZI +2: 254 +4: 209

9/18 AMPS: 275 DOSE: 0.8 UNITS PZI +5.5: 243 PMPS: 300 DOSE: 0.8 UNITS PZI +5: 210 +8.75: 293

9/19 AMPS: 283 +11.5 DOSE: 1 UNIT PZI +5: 186 +5.75: 234 PMPS: 292 +11.75 DOSE: 1 UNIT PZI +1: 253 +4: 220

9/20 AMPS: 284 +11.5 DOSE: 1 UNIT PZI +5.5: 235 PMPS: 274 DOSE: 1 UNIT PZI +4.75: 110/125

9/21 AMPS: 283 +11.5 DOSE: 1 UNIT PZI +4.5: 239 +11: 196 +12: 233 PMPS: 260 +12.25 DOSE: 0.8 UNITS PZI +3: 239 +4.5: 247

9/22 AMPS: 269 +11.25 DOSE: 0.8 UNITS PZI +5.5: 234 +10.75:247 PMPS: 278 DOSE: 1 UNIT PZI +4.75: 101 <======LAST DOSE OF CLAVAMOX

9/23 AMPS: 268 +12.25 DOSE: 1 UNIT PZI +3: 250 +9.75: 275 PMPS: 278 +11 DOSE: 0.6 UNITS PZI +3: 264 +4.75: 203

9/24 AMPS: 310 +12.25 - WHAT HAPPENED TO NICE PRESHOTS? DOSE: 0.6 UNITS PZI +4.5: 209 +6.5: 262 PMPS: 315 +10.5 DOSE: 0.8 UNITS PZI +4: 231 +5: 207

9/25 AMPS: 289 +12.5 DOSE: 0.8 UNITS PZI PMPS: 313 +11.25 DOSE: 0.8 UNITS PZI +4.75: 225 +11.5: 322

9/26 AMPS: 342 +12 after food DOSE: 0.8 UNITS PZI +2: 282 +5: 286 +6: 267 after food +10.75:300 PMPS: 313 DOSE: 1 UNIT PZI +4.5: 165 +5: 204

9/27 AMPS: 322 (+11.5) DOSE: skinny 0.8 UNITS PZI +2: 280 +5.75: 302 - Booster 0.2 UNITS PZI +10.75:293 PMPS: 285 (+11.75) DOSE: 1 UNIT PZI - GAVE 1 DROP METACAM +3: 223 +4.75: 157

9/28 AMPS: 312 (+11.25) DOSE: 1.2 UNITS PZI +5.75: 219 PMPS: 310 (+11) DOSE: 1.2 UNITS PZI +2.5: 255 Back on Clavamox +4.5: 249 According to vet, infection still there. Wants back on Clavamox for 3 weeks. If I can't regulate him at home, vet suggested leaving him there. I told him no way! He drools, swats, and growls there. I am desperate to get sugar out of his urine, so I will have to take drastic measures and switch to Tight Regulation.

9/29 AMPS: 295 (+12.5) DOSE: 1.4 UNITS PZI +2.25: 243 Clavamox +5.5: 215 +11: 283 PMPS: 312 DOSE: 1.4 UNITS PZI +2: Clavamox +4.5: 261 +6: 253 +8: 250 Booster dose: 0.8 UNITS PZI

<=======START TIGHT REGULATION=======> Will try to add food into chart. Starting with regular BSS less 0.5U since he runs lower on Clavamox. Please note that Normy can't eat large portions at a time or he moans from either a stomach ache or bladder pain.

9/30 +3.5 272 +6 262 2U PZI (BSS less 0.5U - since on Clavamox) +2 265 +4.25 214 +6 242 +8 264 2.6U PZI +3.5 237 +4.25 187 +6 211 +7.75 228 2U PZI

10/1 +5.5 235 fed 1oz +8 261 2.4U fed 1/2 clavamox +1 fed 1/2 +3.5 fed 3/4 UG 100/250 +5 fed 1/4 +6 98 +8 130 fed 1/2 +9 171 1U fed 3/4 UG negative +2.45 fed 3/4 clavamox fed 1/2 UG neg +5.75 199 fed 1/2 UG neg +7 227 2U

10/2 +4 fed 1/2 +5.5 252 fed 3/4 1/4 pepcid +6 291 2.4U fed 1/2 +2 fed 1/2 clavamox +2.5 fed 1/2 +5.5 134 fed 3/4 +6.25 125 +10.5 150 fed 1 1/4 +12 168 0.6U +1 fed 1 clavamox +3 fed 1/2 +5 217 +7 317 3U fed 3/4 TOO MUCH FOOD TODAY. CLAVAMOX HUNGRY.

10/3 +3 fed 1/2 +4.5 212 fed 1 +6.5 fed 1/2 clavamox +7.25 157 +7.5 fed 1/2 slc deli turkey +10.5 160 fed 3/4 +11 264 2.4U +.25 fed 1/2 +2.75 250 +4.5 fed 3/4 +5.75 141 fed 3/4 +7 93 fed 1 clavamox +11 166 1.4U fed 1/2

10/4 +4 fed 1/2 +6.5 150 fed 1 1/4 1/4 pepcid +8 234 2U fed 1/4 clavamox +1 fed 1/2 +4 158 fed 1 +4.75 125 fed 1 slc deli turkey UG neg +9.75 275 fed 1/2 +10 2.4U +.5 fed 1/2 +2.25 fed 3/4 +2.5 fed 1/4 +5.25 fed 1/2 Big thunderstorm - no power +5.5 194 +6.5 195 1.4U

10/5 +4.5 fed 1/2 +6 181 fed 1/2 +7.5 234 2.2U fed 3/4 +1 fed 3/4 clavamox UG neg +5 227 fed 3/4 1/4 pepcid +5.75 289 fed 1/2 +6 2.6U +4 fed 1/2 1 drop Metacam for bladder pain +4.5 fed 1/2 +5.75 223 fed 1/2 +6 fed 1/2 +6.5 207 +8 160 fed 1/2 clavamox +10 172 1.6U +10.25 fed 1/2 TOO MUCH FOOD TODAY

10/6 +6 225 fed 1 +7 229 2.4U +1 fed 1/2 +2 fed 1/2 clavamox +2.25 110 fed 1 tsp yog - must go to work, too low too early moaning in his bed before yogurt. +3 80 fed 3/4 - changed mind about work +3.5 79 fed 1/4 +4 90 freedom (runs about 10 points higher than flash) +4.5 fed 1/4 +5 92 freedom +5.75 112 freedom +6 fed 1/2 - work until +10.5

10/6-10/18 On Clavamox

10/19 (Off all Rx meds) +3.5 fed .75 +4.75 88 fed 1 +6 75 +6.25 fed .5 +9.25 134 fed .5 +9.75 148 fed .5 1U PZI 1/4 Pepcid +4.75 204 fed .75 +5.5 fed .75 +6.25 188 +7.25 132 fed .5 +8 fed .75 +8.25 113 +9.25 229 +11 135 +11.25 fed .5 1.4U PZI

10/20 +5.25 fed .5 +6.75 165 +7 fed 1 +8.75 152 fed .5 +12 fed .5 +12.5 170 +12.75 fed .5 1.6U PZI +5 fed 1 +5.25 187 +5.75 fed .5 .5 tsp yogurt +7.25 fed .75 +8 153 0.4U PZI +1.25 fed .5 +4.25 144 +6.25 202 +6.5 fed .5 2.2U PZI +2.5 243 fed .5

10/21 +3.75 fed 1 +5.5 162 fed .5 +7.75 151 fed .5 +8.75 143 fed .5 +9.75 144 +10.75 142 +12 161 2.2U PZI +2 166 +2.25 fed .75 +3.25 fed .25 +4 133 fed 1 +6.5 115 +8.5 127 fed .25 +10 fed .75 +11 138 +13 171 fed .5 2.4U PZI

10/22 +2.25 fed .75 +3.5 108 fed .75 +3.75 fed 1/2 slc turkey +5.25 fed .5 +5.5 115 +7.5 119 +9 fed .75 +11 125 +12.5 135 +12.75 fed .75 +13.75 155 +14 2.4U PZI +0.5 fed .75 +1.5 151 +2.25 fed .75 +4 111 +4.5 fed .5 +9.5 135 fed .5

10/23 +12.25 128 fed .5 +14.5 131 fed .5 +17.5 123 fed .5 +18.5 125 fed .5 +23.5 145 fed .75 +24.5 152 fed .25 +25.75 134 fed .25 +29.25 142 +29.5 fed .75 0.2U PZI

10/24 +5.5 153 fed .5 +7.25 150 +7.5 fed 1.25 1U PZI +1.25 fed .25 +1.5 115 fed .25 1/2 tsp yogurt +4.5 72 fed .75 +5.5 fed .25 +10.5 165 fed 1.25 +11 1U PZI +0.75 fed .25 +1.5 110 fed .75 +4 75 fed 1 slc turkey +5 102 +8 fed .5

10/25 (using Freestyle Freedom from here) +11.25 146 fed .5 +13 166 fed 1.5 +13.25 0.8U PZI +1.25 fed .5 +4.75 119 fed .5 +5.75 116 fed .25 +10.25 184 1.8U PZI +0.25 fed 1.25 +1.5 190 +2.25 fed .5 +3.25 fed .25 1/2 tsp yogurt +4.5 107 +5 fed .5 +9.5 152 fed .5 1U PZI

10/26 +2.5 fed .75 +4 142 +5 fed .5 +5.5 94 fed .25 +9 fed .75 1/4 Pepcid +9.25 138 +9.75 147 fed 1/2 slc turk 1U PZI +4.5 fed .25 +5 147 fed .5 +7 fed .5 +9.25 118 fed .75 +14.5 204 fed .75 2U PZI +1 fed 1/2 tsp yog

10/27 +3 fed .5 +4.5 fed .5 +5.5 122 +8.75 fed .5 +9.25 148 +14.25 165 fed 1.25 +16 209 2U PZI +1.75 fed .75 +2 fed .5 +4 fed .75 +4.5 114 +6 115

10/28 +10 fed .75 +10.25 145 +10.5 2U PZI +2.25 fed .75 +4.5 92 +4.75 fed .5 +5 84 +6 85 fed .75 +8 fed .5 +8.75 129 +10.5 155 2U PZI +1.75 fed .5 +2.5 fed .75 +4.5 93 fed .25 +9.75 fed .5

10/29 +12 149 fed .5 +12.5 146 +14.5 143 +14.75 fed .5 2U PZI +1.5 fed 1 +4.5 fed .75 +5 136 +6 91 fed .75 +8 fed .5 +10 fed .5 +10.25 137 +12.25 131 +15.25 148 fed .5 1/2 tsp yog 2U PZI +0.5 fed .5 +5.5 127

10/30 +9.5 fed .5 +10.75 fed .5 +11.5 94 fed .5 +14.5 fed .75 +15 118 +19.75 fed 1.25 +20.25 186 2U PZI +1.25 fed .75 +2.5 101 fed .75 +3.5 fed .25 +4.5 116 +5 fed .5

10/31 +12.5 145 fed 1.25 +14.5 120 fed .5 +17.75 fed .75 +18.25 147 1.6U PZI +0.25 fed .25 +3.25 fed .5 +5.5 97 fed 1.5 +6.75 fed .5 +9.5 149 +9.75 fed .75 1.6U PZI +2 fed .5 +3 119 fed 1/2 tsp yog

11/1 +8.75 103 +9 fed 1.25 +10.75 109 fed .25 +12 VET!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! +13.25 335 fed .75 1.6U PZI +1 293 fed .5 +5.5 137 +6 fed 1.25 +7 168 1.6U PZI +3 fed .25 1/2 tsp yog +3.5 fed .5

11/2 +12 166 fed 1 +12.25 1.6U PZI +2 fed .5 +5 91 fed .75 +5.5 fed .25 +10.5 fed 1.25 +11.25 168 1.8U PZI +1.5 fed 1 +2.5 fed .5 +4 118 +5.5 119 fed 1/2 tsp yog

Lab results back-Fructosamine 386 Excellent regulation.

No sugar, ketones, bacteria.

LAB BG=315 (STRESS)

Liver ALT value=97 Normal about 60 - still high, but normal for sick cat.

Keep on the milk thistle or take off.

Vet said keep doing what I'm doing otherwise.

11/3 +10.75 fed .5 +12.75 128 fed .75 +14.25 113 fed .75 +18 121 fed .5 +19 fed .25 +23.25 170 fed .75 1.8U PZI +1 fed .75 +2.25 fed .75 +3 fed .5 +5.5 111

11/4 +11 fed .5 +12.75 146 fed 1.25 +14.75 131 fed .5 +16 124 fed .5 +18.75 141 fed .75 +19 1U PZI +2 178 +3 fed 1/2 tsp yog +3.75 173 fed .75 +5.5 fed .75 +6 108 +6.5 fed .5 +8 117 fed .5 +9.25 152 fed .5 1.8U PZI +2.5 fed .5

11/5 +6.5 fed .5 +8 fed .5 +11 fed 1 +11.5 133 +15 165 fed 1/2 tsp yog 2U PZI +2 151 +4 135 fed .5 +5.5 fed .75 +6 99 +6.25 fed .5 1/2 slc turk +8 116 +8.75 fed .75

11/6 +15.75 fed .75 +17 131 fed 1 +19.25 fed .5 +22.75 fed .75 +23 132 +28.25 158 fed 1.5 +29.25 158 +30 fed .5 +30.25 132 +30.75 fed .5 +33.25 122 fed .75 +34 fed .5 +38 175 fed .5 0.4U PZI

11/7 +2.75 fed 1 +4.25 144 fed .5 +5.5 115 +5.75 fed .5

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