New Member - Dosing Advice

[Ann and Blackie]

After reading as much as I have so far in the forum, I realize that I did not start this program properly. The vet did not assume I would be willing to adopt at home testing, although I planned to do so, but he nevertheless instructed me to increase by .5 increments before I had begun testing. I now know that was dangerous. When I did begin testing, my technique was not good and I often could not get blood, so we got off to a rocky start. The vet did suggest that I test for the curve but I was hesitant because I had trouble doing it for several reasons. I was in a learning curve but moved too fast and was shooting blind.

Then on 3/18, we got some low numbers. Initially, I thought that was good until they kept going down that day. We got through that as noted on the spreadsheet. Since then I have increased my study and realize my mistakes. I have read and am continuing to read the PZ instructions on dosing and testing and am making an effort to begin a new start.

I would like clarification from you that my current thinking and plan below is correct and will be the most beneficial for good results over the next few days. I’m aware that there are fine tuning techniques, but I’m looking for basics right now. If you see that something is not correct, please advise.

1. Because of the low readings on 3/18 and because I think I was increasing too fast, on 3/21 I reduced the dosage to 2.5 to try and level off for a while. Is that a wise tactic?

2. I am attempting to test before each meal to be sure that it is safe to shoot.

3. I should not increase dosage for 3 to 6 cycles, then do another curve to see if the dosage should be increased. When I do increase, it should be in .25u increments.

4. Important: Is it correct that I’m testing the curve to determine the lowest nadir reached to determine if increasing is advisable. I test AMPS and PMPS to learn if it is safe to shoot at all.

5. Generally speaking for beginners, if the BS is below 200, give half dose. If the BS is below 150, don’t shoot. I have read complicated instructions for testing again every 30 minutes and skinny shooting, but I’m just looking for basics now.

I will need more help with dosing soon but would just like to know if the above plan will get me through the next few days. I’m sure you can appreciate that there is a lot to absorb, especially for a senior, so I need to move slowly as I’m learning. I have also posted an inquiry regarding diet.

Blackie has been drinking lots of water all this year, but in the past week or so, it has decreased to about half as much. So I’m hoping we’re on the right track.

Thank you so much for your help.

 

[Oscar and Carrie]

Hi Ann,

This all sounds really good to me, and great that you've done so much reading around this.

One thing I would add is that if you ever see a reading below 90 at any point of the cycle, this warrants a dosage reduction. The recommendation here is that you go down doses in 0.25 increments, to ensure you don't accidentally miss the ideal dose.

If the pre-shot reading is below 200, you may want to wait 30-60 mins without feeding and test again to see if the BG has come up enough to be safe to shoot.

Once you get more data on how Blackie responds, you'll be able to start to lower that safe to shoot number.

 

[WYMoreta]

@JanetNJ & @Deb & Wink

Ann,

I've tagged two of the most helpful people I've found on the forum.

I think you've got the basics down, but I am relatively new to this too, and still learning!

 

[WYMoreta]

P.S. Love the pic of Blackie! My what big eyes you have.....

 

[Ann and Blackie]

Hi Ann,

This all sounds really good to me, and great that you've done so much reading around this.

One thing I would add is that if you ever see a reading below 90 at any point of the cycle, this warrants a dosage reduction. The recommendation here is that you go down doses in 0.25 increments, to ensure you don't accidentally miss the ideal dose.

If the pre-shot reading is below 200, you may want to wait 30-60 mins without feeding and test again to see if the BG has come up enough to be safe to shoot.

Once you get more data on how Blackie responds, you'll be able to start to lower that safe to shoot number.

Thank you Oscar...very helpful!

 

[Ann and Blackie]

P.S. Love the pic of Blackie! My what big eyes you have.....

Gizmo looks like a real charmer too! Maybe they should get together!

 

[Deb & Wink]

1. Because of the low readings on 3/18 and because I think I was increasing too fast, on 3/21 I reduced the dosage to 2.5 to try and level off for a while. Is that a wise tactic?

2. I am attempting to test before each meal to be sure that it is safe to shoot.

1. Yes. That BG of 86 on 3/18 earned Blackie an automatic dose reduction, of at least 0.25U. Didn't hurt to drop the dose by a full 0.5U since you did not have much test data to know how low the insulin was taking him.
2. Yes. No food for 2 hours before the pre-shot tests, where possible and your schedule allows. Ok to feed after that and at other times during the 12 hour cycle.

3. I should not increase dosage for 3 to 6 cycles, then do another curve to see if the dosage should be increased. When I do increase, it should be in .25u increments.

3. If you are using the MPM dosing method, that would be correct. If you are using SLGS, it's suggested that you hold the dose for a week, unless the BG levels tell you otherwise.

Besides doing your own BG curve at home, some more random testing during the cycle can fill in the "books" (mid-cycle testing) between the "bookends" (pre-shot tests). Mix it up a bit.

4. Important: Is it correct that I’m testing the curve to determine the lowest nadir reached to determine if increasing is advisable. I test AMPS and PMPS to learn if it is safe to shoot at all.

Yes. But sometimes running a testing curve can tell you if your cat has hit a LOW, and the dose should be reduced.

5. Generally speaking for beginners, if the BS is below 200, give half dose. If the BS is below 150, don’t shoot. I have read complicated instructions for testing again every 30 minutes and skinny shooting, but I’m just looking for basics now.

Good general principles.
Exceptions do occur, for instance if your cat has ketones or has had DKA before. Then skipping the dose is more problematic.

p.s. Curious how your vet diagnosed the heartworms in your cat, and where in the body they were found. Plus what supportive treatment your vet is doing for the suspected heartworm disease.

 

[Ann and Blackie]

1. Yes. That BG of 86 on 3/18 earned Blackie an automatic dose reduction, of at least 0.25U. Didn't hurt to drop the dose by a full 0.5U since you did not have much test data to know how low the insulin was taking him.
2. Yes. No food for 2 hours before the pre-shot tests, where possible and your schedule allows. Ok to feed after that and at other times during the 12 hour cycle.


3. If you are using the MPM dosing method, that would be correct. If you are using SLGS, it's suggested that you hold the dose for a week, unless the BG levels tell you otherwise.

Besides doing your own BG curve at home, some more random testing during the cycle can fill in the "books" (mid-cycle testing) between the "bookends" (pre-shot tests). Mix it up a bit.


Yes. But sometimes running a testing curve can tell you if your cat has hit a LOW, and the dose should be reduced.


Good general principles.
Exceptions do occur, for instance if your cat has ketones or has had DKA before. Then skipping the dose is more problematic.

p.s. Curious how your vet diagnosed the heartworms in your cat, and where in the body they were found. Plus what supportive treatment your vet is doing for the suspected heartworm disease.

Deb, The vet sent in an extensive blood analysis at my request because Blackie had unexplained weight loss, was crying a lot, drinking more water, and didn't feel well. The vet said he was positive for heartworm and stated that the test is only positive when a female worm is present. He sent in a repeat test with new blood, and that one was negative. He then repeated it in his office and it was positive. So 2 out of 3 positive. He said they could kill the worm but the dead worm parts could be dangerous for Blackie. He said they could do scans to determine how much damage had been done but I couldn't see how the treatment would be any different. The treatment was to get him on Prevention Plus to kill future larvae and that the adult would eventually die on it's own. This was my interpretation of what he told me, as I remember, although not as technical. Diabetes was also diagnosed so all of the treatment has been focused on that. Blackie didn't have the respiratory issues that the vet expected with heartworm. We've lived here in Oregon for 4 years and I've yet to see one mosquito, plus he's an indoor cat. Just seems curious.

 

[Deb & Wink]

We've lived here in Oregon for 4 years and I've yet to see one mosquito, plus he's an indoor cat. Just seems curious.

Mosquitoes can sneak into the house, whenever you open the door. Or if you have other pets and they go outside, they could bring mosquitoes inside.

As far as I know, there isn't any treatment for heartworms in cats. There is for dogs, but it causes bad side effects in cats that can be dangerous for your cat.

Found this, about heartworms dying on their own. "Adult heartworms have been known to survive inside a dog's heart for 7 years before they die on their own." From another website, "This generally results in about 80% of cats clearing their infection within 2 to 4 years after diagnosis. "

https://www.maddiesfund.org/feline-heartworm-disease.htm