1/4/20. Wilbur. Increase or hold? AMPS 156. +2 208, +4 169, +6 155, +7 166, +9 138, +11 172

WilbursPerson

WilbursPerson

Member Since 2019
Hey all! Any dosing advice would be appreciated!

Wilbur has had some ups and downs including a 47. Speaking with the vet this week, she suggested that as long as pre shot is around 180 and nadir between 90-150 that I should hold on his doses.

Part of me is happy that he has been stable and mostly blue since 12/31/19 but part of me would like to see better numbers.

thoughts? Hold at 0.5 bid or increase to 0.75 bid?

Thanks in advance!!
 
Hi :)

It looks like you are following SLGS...in which case you would hold this dose since you have only been on it for 3 1/2 days and haven't seen any values below 90. The TR dosing method is different.
Before this though, it looks like you had more dosing changes that were pretty frequent with some of the AM doses being different from the PM dose, so I am not sure. Especially since it looks like your guy had steroid induced Diabetes.
It would be nice if you could grab more test overnight since that is often when most kitties tend to hit lower numbers. This way, you could see what your doses are really doing and how low it is taking Wilbur. My cat often hit his lowest numbers overnight at +7.
Someone with more experience will likely pop in and answer you if you edit your title and add the question mark ( in the drop down menu for the thread tools on the right side).

Here is the sticky from SLGS that mentions when to hold and reduce:

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).
Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Hang in there !
 
Thanks for the reply! I couldn’t figure out how to add the ? mark to my title - uncertain if it’s because I’m on my phone.

agreed - last week was a dosing mess. Between the occasional lower number and some mixed vet messaging, we were all over the place.

one dose per week will always be different - he has to fast for 8 hours for a pill. Historically if I give him a full dose, he gets lowish. Last week we did a 50% dose which seemed to work.

I’m tempted to switch to TR from SLGS. Using TR algorithms, I should increase my dose right?

thanks!!
 
To follow TR, you must be feeding low carb wet or raw food. The Royal Canin select protein foods and glycobalance are medium or high carb foods, depending which protein. For now, I would hold the dose and gather more data. Any chance of getting some tests in the night time cycle, say just before you go to bed? Many cats go lower at night. We determine how to dose the cat based on how low the dose takes the cat.

The ? icon should be part of a Thread Tools drop down that's on the top right of your first post.
 
TR is a bit more " hands on" and I think it would require you to test more at night to make sure you are actually seeing your cats lowest point/nadir. The dosing is always based on the lowest numbers that the dose takes an animal to and not the preshot BGs. It looks like you have seen lower numbers +4 and +6 but there aren't other test around those times for me to see comparisons.

General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Basaglar, & Levemir ISG safe by taking reductions when appropriate.
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.

Even with the fasting for 8 hours... you might be able to give consistent AM/PM doses considering that holding the same dose is likely to give you better results. Even if you fed meals with the AM and PM shot and then offered an evening shot at +2 and maybe another snack at +4 to help them navigate the insulin overnight, but that's up to you. Do you have to do that fast at a certain time of day ?
 
Thanks guys for the replies! Due to health issues in one of our other cats we are somewhat limited in terms of food choices and ingredients. We just can’t risk her getting into Wilbur’s food and separating them 24/7 is not an option for them. Honestly even the glycobalance is iffy because of 1 ingredient in it.

I can absolutely get more data on his glucoses although some days he is clearly done with it ie today.

As for the fasting, we usually would do it overnight pre diabetes but now do it during the day because he has dropped historically (and that way we can grab sugars). So current plan is shoot, at +4 food goes away, fast for 7 hours, then alendronate (chased by 6mls water and butter on nose), then fast for 1 more hour, then food back at +12/shot time.

Getting data is easy but the food situation is harder. We have 4 cats: two without any health issues, Wilbur, and his civvie sister Clark (who is why everyone is on a special diet).
 
Unless you can get all cats on a low carb diet, sounds like SLGS is your dosing method. That's OK. Wilbur is looking pretty good on it.

Have you ever looked at raw food? Lots of good protein choices, with few added ingredients. That's what I ended up on as a compromise for my diabetic and the one other cat with idiopathic cystitis. I tried the vet urinary food, but it was even higher carbs. Vet suggested raw. But that was just two cats. Getting more to agree on a diet change can be a challenge.
 
Wendy&Neko said:
unless you can get all cats on a low carb diet, sounds like SLGS is your dosing method. That's OK. Wilbur is looking pretty good on it.
Click to expand...

thanks. I have some guilt about the diet. We tried: he has always been a grazer, not a bolus eater. Same with everyone else. Separate feeding was a nightmare. I keep telling myself his quality of life includes grazing and hanging out with the rest of the clowder.

for raw foods, do you make your own? Or buy it commercially?
 
WilbursPerson said:
Thanks guys for the replies! Due to health issues in one of our other cats we are somewhat limited in terms of food choices and ingredients. We just can’t risk her getting into Wilbur’s food and separating them 24/7 is not an option for them. Honestly even the glycobalance is iffy because of 1 ingredient in it.

I can absolutely get more data on his glucoses although some days he is clearly done with it ie today.

As for the fasting, we usually would do it overnight pre diabetes but now do it during the day because he has dropped historically (and that way we can grab sugars). So current plan is shoot, at +4 food goes away, fast for 7 hours, then alendronate (chased by 6mls water and butter on nose), then fast for 1 more hour, then food back at +12/shot time.

Getting data is easy but the food situation is harder. We have 4 cats: two without any health issues, Wilbur, and his civvie sister Clark (who is why everyone is on a special diet).
Click to expand...


I was feeding the glycobalance too but we kept having too many bounces and higher AMPS numbers so I phased it out. My guy was a grazer too...which is why feeding every 12 hours wasn't going to work. He eats 3 meals during the day and then continues to snack overnight. I also make sure that I give him another smaller meal after his injection- about 1-2 two hours later because he doesn't always finish his meals when we are also doing the insulin injection. This way I can get some food into his system and help him slide his BG down with the insulin starts to work around +5.
I had recently looked into feeding another low carb/ low phosphorous diet for my guy...if your other cat has food issues maybe another limited ingredient food would work - if you aren't able to try a raw diet.

https://kohapet.com/collections/limited-ingredient-diet-pate

here is a previous post where there was some raw diet discussions
http://www.felinediabetes.com/FDMB/threads/diabetes-and-allergies.223572/#post-2500698

https://catinfo.org/making-cat-food/
 
Thank you for the suggestions! For the cat with food issues, she has a list of ingredients to avoid because of allergies/risk of recurrent pancreatitis/IBD. We are on limited ingredient medium carb RC for her and the glycobalance at the vets suggestion.
 
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