? Should I reduce the dose?

Georgiana & Perlutz

Georgiana & Perlutz

Member Since 2019
So again Perlutz’s numbers have changed over the past few days and I am thinking he might need a small reduction? I’m thinking 2.25. Thoughts?

He was eating some Purina pates before but I’ve stopped them after finding they contain sugars:banghead: I’ve learnt my lesson to check labels constantly from now on as previous cans of this pate didn’t have the sugar listed but now they do. I don’t know if there’s been a recent change in ingredients or what, but I’m glad I checked on a recent batch I bought. I’m thinking cutting this food is what changed to these lovely yellows and blues.

As some of you might know, he has seen a specialist vet recently and they believe he has some GI issues. He has been prescribed Metronidazole and Omeprazole but only got the Omeprazole 3 times and then he had 2-3 not so great days last weekend with up to 4 times vomiting bile in a day and loss of appetite and we stopped it. I’ve been giving him SEB instead, 1/4-1/2 capsule sprinkled on his food everyday the last week and he has been much better! No vomiting since and his appetite is normal.

Looks like he also has early CKD. I have yet to find a diet that ticks the boxes for both diabetes and CKD, I bought some raw food from nature’s menu but it’s not Perlutz’s cup of tea so I’m gonna have to find something else. I will email Applaws to find out the phosphorus content in the food he is eating, although I have a feeling it will be relatively high.

I’m gonna link my previous post with more details for anyone who’d like to have a read http://www.felinediabetes.com/FDMB/...st-results-gi-inflammatory-diagnostic.215814/
 
I think with 2 days in a row of reduced pm doses, and a skipped pm dose earlier in the week, it would be worth trying 2.25 for a few days to see if Perlutz can balance out the day a little bit.
 
Wow! That's a really lovely cycle last night. It looks like you dropped to 1.5 today. I can't recall if you can usually monitor throughout the day or not. I can say that 1.5 should surely be safe for the day, which I know must be nice after last night! Perlutz did stay in good, safe numbers last night, but I know those greens can freak you out when they aren't normal!

Let's see what happens with that number today. My guess is that you might want to go a little higher tonight with the dose, but today should help us determine that. :)
 
Rachel said:
Wow! That's a really lovely cycle last night. It looks like you dropped to 1.5 today. I can't recall if you can usually monitor throughout the day or not. I can say that 1.5 should surely be safe for the day, which I know must be nice after last night! Perlutz did stay in good, safe numbers last night, but I know those greens can freak you out when they aren't normal!

Let's see what happens with that number today. My guess is that you might want to go a little higher tonight with the dose, but today should help us determine that. :)
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Yes, his evening cycles have been very nice! Even the yellows and occasional blues are still lovely for us!

I can't test throughout the day but I'm about to run home for lunch and I'll at least get 1 reading.

I'll update once I'm back :)
 
Given the low values you got yesterday, I would definitely not go back up to 2.5 I need to go take care of something here, but will check back in on Purlutz in a bit
 
I don't ever want to discourage folks from pitching in around here, so first of all @Peacock, thank you for sharing your thinking, and I hope you'll continue to do so. That's exactly how this board keeps going all these years.

Now here's the "however" ;)....We can't determine dosing by averaging previous doses. We have to base it on the nadir, pre-shots, duration, onset, drop/impact, other health conditions, and the big picture of recent cycles, so there is a complexity that is essential to consider along the way.

It's fine for cats to get close to the take action number, as it's the "take action" number, it's not the "danger" number. So that cycle was actually really good, and I wouldn't want to steer away from that range. Especially considering it's the PM cycle when most cats run lower. If it happens during an AM cycle, i treat it with a bit more caution, although still celebrate those healthy, healing hours. I don't consider that cycle a reason to lower the dose.

My hunch is that Perlutz could handle the regular dose on those blue numbers, but we aren't there yet to know for sure. Georgiana is doing the right thing by lowering the dose, collecting data, and then the next time trying a little more and collecting more data, rinse and repeat. She's working her way towards giving the full dose on a blue. We don't want to do that right away though since for some cats it's a very bad idea, while for others it works just fine. So she's taking her time and testing the waters, to figure out what works for Perlutz.

So I would think that 2.25 is a pretty good spot to be right now. We don't want to give too little insulin and have a cat run higher than necessary unless there is reason to be concerned about a symptomatic hypo, and so far, I don't see that. The green numbers are scary when they first start to appear, but they are exactly what we're aiming for. :D :bighug:
 
First of all, thank you both for your input.

I decided to go with 2.25 tonight instead of lower because lower doses, even on lower PMPS haven’t done enough during the cycle. While it might keep me on my toes during the night, like Djamilla said, he got close to take action, but not quite there. He stayed safe with minimal amounts of food and I didn’t need to bring out the high carb, which is good. Perlutz seemed absolutely fine, the most important. If anything, he was just annoyed that I kept waking him up for testing :joyful: Given the situation, which is relatively new for us, I stayed calm and collected and didn’t go into panic mode and that’s thanks to this forum - hats off to everyone for taking off their time to help and teach others.

It’s nearly bed time for us so I’ve tested him. He is still high at 23.1 (exact same value as PMPS) so it looks like no greens or blues tonight. He has had 2 higher carb treats tonight at PMPS (12% from Nature’s Menu) and I wonder if they could be partially “guilty” for this. He doesn’t normally have any treats, he doesn’t like the freeze dried ones and couldn't find any other decent treats but today he was playing hide and seek at test/shot time so I gave him the 2 in exchange for his collaboration. It’s done now, can’t do anything about it.

Even though he’ll be in high numbers throughout the night most likely, I’ll set up an alarm for +6 or so to collect more data. I knew since diagnostic that we need to regulate the diabetes, but more recently, with all the other health problems that are slowly creeping out on us, it’s really hitting home how much we need to gain some control.
 
2.25 is probably what I would have done too. My main reason for suggesting anything lower temporarily was to help avoid some of the reduced shots you were giving. I deleted one of my posts because someone might think I was suggesting averaging doses, when I merely meant to point out a coincidence, with my geeky love of numbers.

Hopefully you get some sleep in between tests. :bighug:
 
So Perlutz had another good day, probably his best so far in terms of BG :D I could only test him in my lunch break so it’s been a stressful afternoon but all was fine, phew!

Looks like 2 units worked well so I kept that dose for PM. I’m going to test again before bedtime and take it from there but I might need to wake up and get some night tests (no more snoozing :facepalm:).

Previously, his numbers changed with each new insulin vial and a new one is due to arrive in 1-2 days... And then 2 weeks tomorrow I am going to be away for 11 days :nailbiting: I’m wondering wether I should stick to this vial for this time to have some consistency for a bit longer (if these numbers last, of course)? We’ve had the current vial for 1 month this week and it seems to be working fine.

EDIT: The insulin vial was opened a month this week but we’ve only been using it for a little over 2 weeks, I got a little confused there
 
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I'm not sure if I'm understanding your post, so just to clarify: if Prozinc is stored carefully in the fridge and not shaken, it should last for much more than one month. I used my first vial for nearly six months with no loss of efficacy. So it should be fine to continue using throughout the time you are away.
 
@Djamila we store it properly, never shake it. It's just me being miles away when I went to pick up some food the other day and I ordered a new vial thinking we've had this one since end of May and I wanted to make sure there's enough insulin at home for when I am away. Buuut I completely forgot I had to buy a new vial while he was hospitalized for tests at the referral vet, which is the one we are using now.

Seems like 2 units works well for Perlutz and I really like these numbers we're seeing :cat:
 
Loving the yellow pre-shots, and yesterday's curve really make me smile!
So glad you're seeing some progress at last - you've worked really hard and deserve it.
Interesting too that his tummy seems better since you've been giving the SEB - long may it continue!
 
@Diana&Tom yes, SEB seems to be working wonders! Only had 1 hairball since starting him on it.

Found this the other day

Blood sugar balancing The mucilaginous soluble fiber in Slippery elm plays a role in controlling blood sugar levels. Soluble fiber delays gastric emptying. This results in steadily slowing sugar absorption into the blood through the lining of the small intestine thus lowering the glycemic index of food especially simple sugars. Soluble fiber also inhibits pancreatic enzymes which break down starches into simple sugars
 
Georgiana & Perlutz said:
@Diana&Tom yes, SEB seems to be working wonders! Only had 1 hairball since starting him on it.

Found this the other day

Blood sugar balancing The mucilaginous soluble fiber in Slippery elm plays a role in controlling blood sugar levels. Soluble fiber delays gastric emptying. This results in steadily slowing sugar absorption into the blood through the lining of the small intestine thus lowering the glycemic index of food especially simple sugars. Soluble fiber also inhibits pancreatic enzymes which break down starches into simple sugars
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How interesting! Double the benefits. What's the source? Is it this:

https://www.brettelliott.com/detox-blog/slippery-elm-ulmus-rubra-herbal-monograph
 
Georgiana & Perlutz said:
Hmm 17.1 at +5.5...
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Hmmm maybe he could have done with a smidge more this morning - his pre shot was higher than yesterday's so maybe you need to find a sort of sliding scale where you give x units at x bg and y units at y bg... now you're getting lower numbers generally there may be even more need to fine-tune.... try more fat and skinny dosing?
 
I might have to look into the sliding scale protocol, it might be what he needs.

Because AMPS was higher, I thought I’d see a blue at midday, didn’t expect pink :blackeye: But Perlutz is nothing but full of surprises so we’ll see.
 
Georgiana & Perlutz said:
I might have to look into the sliding scale protocol, it might be what he needs.

Because AMPS was higher, I thought I’d see a blue at midday, didn’t expect pink :blackeye: But Perlutz is nothing but full of surprises so we’ll see.
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Well, see what @Djamila and @Rachel think about sliding scales... it makes sense in a way but the inconsistency goes against what your vet wants you to do, and it may even create more confusion... we just don't know. The others will have a good take on this I'm sure. I'm not experienced enough to give dosing advice as such but from what I can see at the moment, a dose somewhere between 2u and 2.25u seems to be working quite well for now so it may just be a question of minor tweaks.
 
As I said earlier, he is nothing but full of surprises - 3.6 at +11.5 :eek:

He is eating now and I am really not sure what to do with insulin tonight! Skip entirely? Test again in half an hour to an hour and give a drop? What do I do? :arghh:
 
Georgiana & Perlutz said:
As I said earlier, he is nothing but full of surprises - 3.6 at +11.5 :eek:

He is eating now and I am really not sure what to do with insulin tonight! Skip entirely? Test again in half an hour to an hour and give a drop? What do I do? :arghh:
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Wow. That is definitely a no-shoot number. Interesting response today! Yes, test again in 30-60 minutes (but remember, the number could be food-influenced) and see what he's up to then - maybe post again here and see who's around to advise? Remember the golden rule - you shoot on the rise - so if he's suddenly shot up above and beyond what you could expect from a food spike, you could give a 2u dose, or if he's borderline shootable, either a token dose or half the usual dose maybe. Hard to say - he is certainly leading you a merry dance. It's possible that Mr Pancreas has come out to play again today - this intermittent "sputtering" is very confusing and you can't predict it, you just have to stay alert to the possibility and act (or not) acccordingly.

Keep your ss up to date and hopefully Djamila and Rachel might pop in soon.
 
Mr Pancreas is borderline naughty! Made my heart skip a beat when I saw the 3.6, I checked few times to make sure it’s not actually 36 which wouldn’t have been too surprising for Perlutz after +5 of 17.

I’ll check again him again soon!
 
Georgiana & Perlutz said:
Mr Pancreas is borderline naughty! Made my heart skip a beat when I saw the 3.6, I checked few times to make sure it’s not actually 36 which wouldn’t have been too surprising for Perlutz after +5 of 17.

I’ll check again him again soon!
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Yes it is rather alarming but the more unexpected low numbers you get the better really, if it means the pancreas is healing. It is starting to look as if you've broken through the glucose toxicity of a few weeks ago although yes, Perlutz being who he is it would not be surprising to see another red or black again soon. The key to keeping it under control as much as possible is of course testing and I think you have as good a handle on this as anyone now and can dose according to your instinct a lot of the time. Interesting to see the next number!
 
Georgiana & Perlutz said:
+12 4.8 so a little increase from the food
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Not much though!
What time do you usually shoot, I forget? 5.30-6pm ish maybe? How long can you delay shooting (if you need to) before it starts messing with your schedule in the morning?
I hope someone else chimes in with a more experienced opinion, but FWIW I'd say that you can only continue to monitor and if/when he starts to rise, give a drop then to stop too fast a climb. But it may be that he's simply having a really good day, his pancreas is helping out and/or he had a late onset or long duration from this morning's dose... and he won't need anything at all tonight... who knows!
 
We normally shoot between 6-7PM, depending on the time we get home and how Perlutz is eating, but normally is around 6:30 (half an hour ago). Latest I can shoot will be 8-8:30 (1-1.5hours from now) so I can still do tomorrow morning before work.

Just want to make sure I understood right, you think I could give a drop at any time later if he rises?
 
Georgiana & Perlutz said:
We normally shoot between 6-7PM, depending on the time we get home and how Perlutz is eating, but normally is around 6:30 (half an hour ago). Latest I can shoot will be 8-8:30 (1-1.5hours from now) so I can still do tomorrow morning before work.

Just want to make sure I understood right, you think I could give a drop at any time later if he rises?
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If he is definitely rising, and a "drop" might halt too fast a rise without messing with tomorrow's schedule, then I don't see why you can't do that. If he's going high and you skip a dose, he's going to be through the roof again in the morning. I'd still like to hear what the PZI experts say, but if you say you could delay tomorrow morning's shot until around 8.30, see what he's doing at 8.30pm tonight and make a decision then. Just trying to think logically...
 
+5.4 just now at +1.5 (this would normally be his +1 but we were nearly 30min late with insulin this morning). So it is on the rise, but could be just the food. He isn’t lethargic but not lively either, he’s just chilling/sleeping on the bed. I’m not sure if I’m brave enough to shoot anything at all, although I know that might cause a massive spike. It’s just a new situation for us and you know me by now, I used to skip a dose on higher numbers than today and then I gradually started shooting lower numbers gradually increasing from 0.25 to nearly a full dose. I’m slow like that I guess and not always brave enough.

I too hope someone else will chime in.

A thought to cancel my upcoming trip is starting to creep in...
 
Still too low to shoot, in my opinion. He may be surfing nicely in single digits for a while longer yet, or he may suddenly shoot up. I don't think you're not brave at all, this is unknown territory!

Not sure what time it is for our US friends but hopefully someone will pop in soon and if they think it would be ok to give a tiny dose if he's gone up more by then, take it from there...?
 
Have you checked Perlutz's BG again recently? I think it may be too late for you to shoot now to stay on a schedule that works. Sorry just seeing this post now.
 
MrWorfMen's Mom said:
Have you checked Perlutz's BG again recently? I think it may be too late for you to shoot now to stay on a schedule that works. Sorry just seeing this post now.
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Hi Linda, I just did - 7.4 @+4.5. He has had a tiny bit of food about an hour ago.

I decided to skip and instead use tonight as data (I keep using this word) for the future, should we have this situation again. He is rising, but quite slowly (for now).

What do you think? Should I have given some?
 
I think that is a bit of a toss up. He had some nice readings on the 7th then bounced way up and came down relatively quickly to some good numbers yesterday, bounced a bit again but cleared that super quick. That may be sign that he is getting more used to those lower numbers. After that 3.6 today, I'd definitely reduce the dose by 0.25u down to 1.75u if pre-shot tomorrow is high enough to shoot. I'd be a bit more conservative about your shoot number right now till you figure out what his game plan is since you can't monitor through the day. It's always possible to give a big chicken shot if pre-shot is lower but when the pattern changes, it's tough to know just how much to reduce so given it's a night cycle,I think you made the right decision tonight. :)
 
Georgiana & Perlutz said:
@Marje and Gracie I saw you were online and I'm hoping you don't mind the tag :oops: Perlutz is full of surprises this week and tonight I'm struggling with what to do!
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I’m so sorry I didn’t see this before I popped off. However, because I never used PZ, I prefer to let those experienced with it do the advising. I’m a big proponent of members not advising on insulin they haven’t used. I don’t know what they typically use as a reduction number but a 65 on an AT using Lantus or Levemir would earn a 0.25u reduction.

I’m sorry if an experienced PZ user did not respond to you in time. :bighug::bighug::bighug:
 
MrWorfMen's Mom said:
I think that is a bit of a toss up. He had some nice readings on the 7th then bounced way up and came down relatively quickly to some good numbers yesterday, bounced a bit again but cleared that super quick. That may be sign that he is getting more used to those lower numbers. After that 3.6 today, I'd definitely reduce the dose by 0.25u down to 1.75u if pre-shot tomorrow is high enough to shoot. I'd be a bit more conservative about your shoot number right now till you figure out what his game plan is since you can't monitor through the day. It's always possible to give a big chicken shot if pre-shot is lower but when the pattern changes, it's tough to know just how much to reduce so given it's a night cycle,I think you made the right decision tonight. :)
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I can't test throughout the day, only once at lunch but I'm working on a way to check on him remotely.

The reduction makes sense but for the morning I kept the 2 units, he was 30.6. I'm curious to see what happens at PMPS now...
 
Marje and Gracie said:
I’m so sorry I didn’t see this before I popped off. However, because I never used PZ, I prefer to let those experienced with it do the advising. I’m a big proponent of members not advising on insulin they haven’t used. I don’t know what they typically use as a reduction number but a 65 on an AT using Lantus or Levemir would earn a 0.25u reduction.

I’m sorry if an experienced PZ user did not respond to you in time. :bighug::bighug::bighug:
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Oh I didn't even think to check what insulin you are using :facepalm: I was tagging everyone I knew from previous posts :oops:

When you have a moment, could I ask you to have a look over some new blood tests for Perlutz, please? I had some tests repeated and also got him tested for acro (result is not back for acro yet). Thank you :bighug:
 
Well, that worked out fine but I definitely think you should decrease the dose to 1.75u given that low of 3.6 yesterday. I'm a bit surprised he's that low again. Expected that part of that high AMPS was from a bounce as well as the skipped shot but it appears it was mostly the skipped shot or he has cleared the bounce very quickly or the dose is too high.
 
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