? 01/01/2022 MICIO: AMPS 258 / 126@ +3 / 142@ +5.75 / 177@ +8.75 / PMPS 185

MISSY + Simone&MICIO (GA)

MISSY + Simone&MICIO (GA)

Member Since 2021
Yesterday: AMPS 257 / 203@ +3 / 193@ +4.75 / 192@ +7 / PMPS 15O / 134@ +3 / 182@ +5.5
Another 6th cycle at 4.25u ended, numbers are still slowly dropping, Micio is feeling better and he's not drinking and peeing quite as much.
We had an appointment with the vet yesterday and, surprisingly enough, she was surprised to know about all the testing I have been doing and very interested on the spreadsheet and the graph copy I brought to show her..
Dr. thinks Micio is responding well to insulin (no reason to test him for Acromegaly or other high dose conditions) and suggested not to up the dose more than 4u and she believe cats should be on the low 200's and numbers on the green are too low and could easily lead to hypos ...Kinda confused in here as I thought we were aiming for 50-120 numbers?! Is it because she uses Alphatrack meter, so numbers run higher?

At what numbers do I stop increasing the dose?
I just realized that PMPS numbers tonight were at 185 but gave him 4.25u insulin anyway...should I have not given him a full dose?
@Wendy&Neko , @Bron and Sheba (GA) , @Sienne and Gabby (GA) if you can find the time, I would greatly appreciate your opinion. https://felinediabetes.com/FDMB/thr...22-154-3-147-5-5-173-9-pmps-202-118-3.257242/
Tnx again
 
I have to respectfully disagree with your vet. I think the question is whether the vet believes that cats can go into remission or be tightly regulated. I would not consider numbers in the 200s to be tightly regulated and those numbers are nowhere close to remission. The other question is what is your goal for Micio?

Many vets will discourage caregivers from having their cat in normal range numbers. Part of this is due to their fear of hypos. The rationale makes sense from the perspective of the vet not being available 24/7 and from not strongly encouraging caregivers to home test. If the vet told you to try to get your cat into normal range and you were not dutifully testing, there's a good chance someone would sue the vet if their cat had ill effects from a symptomatic hypoglycemic episode. As you know, we're rather vocal about home testing as a means of keeping a cat safe. In addition, there are usually people here pretty close to 24/7 along with written guidelines for managing low numbers.

Another point to consider is the fundamental nature of diabetes. FD is hard on the kidneys. One of the most common problems with aging cats is kidney disease. The sooner you can get a diabetic cat's numbers below renal threshold, the better. Getting a cat tightly regulated or into remission is a good way of reducing the risk for kidney issues.

As for the amount of the dose, a cat needs as much insulin as the cat needs to get the numbers where you want them. Setting 4.0u as an amount is an artificial decision that's not based on how much insulin your cat may need to get numbers in a good range. You have data. If Micio were my cat, I'd be increasing the dose at AMPS unless his numbers indicate a dose reduction this evening. You follow TR as your dosing guideline. You keep increasing the dose until numbers are in normal range. You did fine!!!

As for testing for acromegaly, I suspect if we had a few dollars for every time we told a member here to tell their vet to "humor me" and get tests for acromegaly and insulin resistance run, we could keep FDMB afloat for quite some time. I suspect Wendy would agree!! Vets are taught that acro is a rare condition. I believe the current statistics is that it occurs in 25% of cats. It's not that rare.
 
I agree with Sienne. Different cats need different doses of insulin to get them into normal numbers. Stopping at 4 units and keeping Micio no lower than the low 200s is only doing half the job. You need to keep increasing the dose, as per the TR protocol until Micio is regulated with BGs in the 50 to 120 range, or ideally under 100.
Remember, if you are testing the BGs you are in control and can stop any hypos by feeding and testing.
I would increase the dose tomorrow as well, if you don’t see green this evening.
You are doing a really good job, following the protocol and increasing appropriately.
 
Sienne and Gabby (GA) said:
I have to respectfully disagree with your vet. I think the question is whether the vet believes that cats can go into remission or be tightly regulated. I would not consider numbers in the 200s to be tightly regulated and those numbers are nowhere close to remission. The other question is what is your goal for Micio?

Many vets will discourage caregivers from having their cat in normal range numbers. Part of this is due to their fear of hypos. The rationale makes sense from the perspective of the vet not being available 24/7 and from not strongly encouraging caregivers to home test. If the vet told you to try to get your cat into normal range and you were not dutifully testing, there's a good chance someone would sue the vet if their cat had ill effects from a symptomatic hypoglycemic episode. As you know, we're rather vocal about home testing as a means of keeping a cat safe. In addition, there are usually people here pretty close to 24/7 along with written guidelines for managing low numbers.

Another point to consider is the fundamental nature of diabetes. FD is hard on the kidneys. One of the most common problems with aging cats is kidney disease. The sooner you can get a diabetic cat's numbers below renal threshold, the better. Getting a cat tightly regulated or into remission is a good way of reducing the risk for kidney issues.

As for the amount of the dose, a cat needs as much insulin as the cat needs to get the numbers where you want them. Setting 4.0u as an amount is an artificial decision that's not based on how much insulin your cat may need to get numbers in a good range. You have data. If Micio were my cat, I'd be increasing the dose at AMPS unless his numbers indicate a dose reduction this evening. You follow TR as your dosing guideline. You keep increasing the dose until numbers are in normal range. You did fine!!!

As for testing for acromegaly, I suspect if we had a few dollars for every time we told a member here to tell their vet to "humor me" and get tests for acromegaly and insulin resistance run, we could keep FDMB afloat for quite some time. I suspect Wendy would agree!! Vets are taught that acro is a rare condition. I believe the current statistics is that it occurs in 25% of cats. It's not that rare.
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Agree on all the above. I do think my vet is a good doctor but may just go by the book for some things; matter fact she's didn't appear to know about the FDMB group, the TR protocol I'm following and wanted me to explain to her the spreadsheet copy I brought, but at least she's not against home testing.
But she got pretty concerned when she learned that the Dr. at the ER two weeks ago gave Micio and injection for possible "inflammation" that is actually pretty bad for kidney (Micio's stage 1-2 CKD and they knew it as I forwarded them previous and recent bloodwork) ...so hopefully no further damage was done. Still taking him to a board certified dentist for possible dental/extraction but appointment is on March, Meanwhile we'll see if infection or whatever it was will occur again.
And yes, I saw the statistics about acromegaly...pretty sad, hopefully not Micio's case.

Does Micio even got a chance of getting into remission with all the issues and his age? I'd be content if he'll be stable at a reasonable number, he's doing so much better in the last week or so...
 
Bron and Sheba (GA) said:
I agree with Sienne. Different cats need different doses of insulin to get them into normal numbers. Stopping at 4 units and keeping Micio no lower than the low 200s is only doing half the job. You need to keep increasing the dose, as per the TR protocol until Micio is regulated with BGs in the 50 to 120 range, or ideally under 100.
Remember, if you are testing the BGs you are in control and can stop any hypos by feeding and testing.
I would increase the dose tomorrow as well, if you don’t see green this evening.
You are doing a really good job, following the protocol and increasing appropriately.
Click to expand...

Agree, I feel we're getting pretty close and won't give up now...At what number it's not safe to shoot or I should only give him a reduced dose? Thought I read no shoot under 200?!
And, when you guys say to hold the dose longer when bg's are in the lower 100s, what number exactly is considered low enough to hold?
Tnx
 
We hold doses with blue nadirs for 6-10 cycles. I tended to longer for lower blues, like 100's or 11x. With green nadirs we hold for 10 cycles. You haven't yet seen green, though I hope it's not too far off.

Sienne and Gabby (GA) said:
I suspect if we had a few dollars for every time we told a member here to tell their vet to "humor me" and get tests for acromegaly and insulin resistance run, we could keep FDMB afloat for quite some time. I suspect Wendy would agree!! Vets are taught that acro is a rare condition. I believe the current statistics is that it occurs in 25% of cats. It's not that rare.
Click to expand...
i had to practically beg my vet to get the tests done. The clinic owner called them "exotic tests" - his words. Vets of a certain age were taught "this is acromegaly, you'll never see it". The paper showing it's 25% of diabetics in the UK came out in 2015, so that is relatively recent. There have been a couple other studies in other countries showing the percent is 20-25%, with doses in the 1-30 unit range, average of 7 units. And I've seen higher doses here. My vet, and also the clinic owner were willing to learn. Clinic owner did at one point admit I knew more than he did about the condition. :) Anyway, not something I'd worry about with Micio just yet.
 
Wendy&Neko said:
We hold doses with blue nadirs for 6-10 cycles. I tended to longer for lower blues, like 100's or 11x. With green nadirs we hold for 10 cycles. You haven't yet seen green, though I hope it's not too far off.


i had to practically beg my vet to get the tests done. The clinic owner called them "exotic tests" - his words. Vets of a certain age were taught "this is acromegaly, you'll never see it". The paper showing it's 25% of diabetics in the UK came out in 2015, so that is relatively recent. There have been a couple other studies in other countries showing the percent is 20-25%, with doses in the 1-30 unit range, average of 7 units. And I've seen higher doses here. My vet, and also the clinic owner were willing to learn. Clinic owner did at one point admit I knew more than he did about the condition. :) Anyway, not something I'd worry about with Micio just yet.
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"Exotic" ..that's awesome:)
Let me make sure I fully understood...when you guys say nadirs, do you mean the lowest numbers during the day/cycle or at pre-shoot?o_O So, i should NOT increase to 4.5u tomorrow morning? Instead keep the 4.25u for 2 more days/ 4 cycles? If so, after 10 cycles, if numbers still low 100s or lowered to green, do I just keep the same dose at 4.25u? This is the part I'm getting nervous about and not sure I fully understand...
 
By nadirs I mean, how low does the dose take the cat. It can vary and be an anytime in the cycle. Some like to nadir earlier, some later, some mix it up, things like bounce breaking cycles have later nadirs.

Our goal is to get Micio to start seeing some green numbers (under 100). Unless you see them tonight, I think you'd be fine to increase tomorrow.
 
Wendy&Neko said:
By nadirs I mean, how low does the dose take the cat. It can vary and be an anytime in the cycle. Some like to nadir earlier, some later, some mix it up, things like bounce breaking cycles have later nadirs.

Our goal is to get Micio to start seeing some green numbers (under 100). Unless you see them tonight, I think you'd be fine to increase tomorrow.
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OK, so...surprise-surprise! AMPS 197 this morning so I up the dose to 4.5u. then we got 64@ +3.5 and gave him some higher carb canned food and a bit of honey, tested him 1/2 hour later and he was 69@ +4 (a bit higher but not much).
That seemed a significant drop for the first time...How concerned should I be? Beside keep testing him, what else should I do? If it continues to stay this low by PMPS do I skip or reduce the dose?
Sorry but kind of panicking a bit..
 
The reduction number is under 50. With a 69 I would have given mc but not honey. It’s not concerning at all. Some cats respond quickly to a new dose and then settle in. Others see new dose wonkiness. Remember normal bg is 50-100. He’s at a good place. You want him to see lots of green. Save the honey for 50’s if early in the cycle. Flat green is what you want.

Post for dosing advice tonight if lower than you are comfortable and stall without food until you get a reply. Retest in 20 minutes.

Have you printed out the sticky on how to handle low numbers as well as the methods. I had them right next to my computer and read them over and over while waiting for the next test.

A reduction is earned if the bg goes under 50 so unless that happens it’s not earned.
 
tiffmaxee said:
The reduction number is under 50. With a 69 I would have given mc but not honey. It’s not concerning at all. Some cats respond quickly to a new dose and then settle in. Others see new dose wonkiness. Remember normal bg is 50-100. He’s at a good place. You want him to see lots of green. Save the honey for 50’s if early in the cycle. Flat green is what you want.

Post for dosing advice tonight if lower than you are comfortable and stall without food until you get a reply. Retest in 20 minutes.

Have you printed out the sticky on how to handle low numbers as well as the methods. I had them right next to my computer and read them over and over while waiting for the next test.

A reduction is earned if the bg goes under 50 so unless that happens it’s not earned.
Click to expand...
Just tested him and he's at 81. What's mc? I didn't give him much honey at all, just a lick and then higher carb food a few times.
I do have the HYPO kit ready.
Will post more tonight. Thank you!
 
tiffmaxee said:
Hc food is around 15 or 20%+. It depends how carb sensitive your cat is.
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UPDATE: Mico was 82@ +5.5 / 91@ +7 / 99@ +9 and next I will test at PMPS (in 30 minutes). If BGs stay in this range guess I'll just shoot 4.5u, so no need to post for dosing advices, correct?
I apologize for panicking for no reason but those lower number really took me by surprise and, although that's the range we want to see, it made me worry what's going to happen when I'll give him next dose since this one made his numbers jumped that low
Will update later on
 
Nice pmps. Almost everyone gets nervous at lower numbers than they are used to seeing. You are not alone. Frankly I worry more about those who don’t get nervous at least at first. Everyone need to take lower bg seriously but know how to handle those numbers with food and testing to keep the cats safe.
 
tiffmaxee said:
Nice pmps. Almost everyone gets nervous at lower numbers than they are used to seeing. You are not alone. Frankly I worry more about those who don’t get nervous at least at first. Everyone need to take lower bg seriously but know how to handle those numbers with food and testing to keep the cats safe.
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Thank you.... So, as I'm still trying to understand how this works, if by increasing to 4.5u at AMPS made the numbers drop that much, how do we know that by shooting another 4.5u at PMPS won't make him hypo?
 
We have no idea what he will do. That’s why you test. Max hit green nadirs early in but didn’t drop under 50. That’s why you test. If you see numbers dropping feed the curve to avoid low numbers. If you do that you won’t have a hypo. The numbers might drop into the 50’s but that is normal bg. I never had a symptomatic hypo, even when Max was in the 30’s. Micio had not had low numbers yet. He just was lower than you are used to seeing. Have you looked at other people’s spreadsheets? There are plenty that are almost all green with some blue.
 
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tiffmaxee said:
Look at the 2021 ss fir George and Kahlua.
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I don't know how to find that, I tried type in that name on the FDMB search but nothing comes up...
I was looking through some comments on the FB page trying to understand why people don't recommend to shoot under 200 or how do I know what's my "NO SHOOT" numbers for Micio? Feeling very overwhelmed right now as I worry about not doing the right thing or even worse, misunderstanding things and eventually put my baby in danger...going to test him again now
 
MissyKat said:
I don't know how to find that, I tried type in that name on the FDMB search but nothing comes up...
I was looking through some comments on the FB page trying to understand why people don't recommend to shoot under 200 or how do I know what's my "NO SHOOT" numbers for Micio? Feeling very overwhelmed right now as I worry about not doing the right thing or even worse, misunderstanding things and eventually put my baby in danger...going to test him again now
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One member is @Hshray and the other kahulasmom. Those are just two that posted recently.

Our Facebook groups is not supposed to give dosing advice.

If you want to get him regulated and possibly otj and you follow TR then shooting low comes with that. Being high puts stress on the kidneys. Right now if you get a bg below 150 at shot time, stall, don’t feed and retest in 20-30 minutes and then ask for dosing advice. Eventually with data peoples shoot 50+.
 
tiffmaxee said:
One member is @Hshray and the other kahulasmom. Those are just two that posted recently.

Our Facebook groups is not supposed to give dosing advice.

If you want to get him regulated and possibly otj and you follow TR then shooting low comes with that. Being high puts stress on the kidneys. Right now if you get a bg below 150 at shot time, stall, don’t feed and retest in 20-30 minutes and then ask for dosing advice. Eventually with data peoples shoot 50+.
Click to expand...

Finally found George's ss: I see giving insulin with numbers lower than 100 at PS but the dosage is much lower than 4.5u...I'd feel safer with that small amount probably
Why even give insulin with those numbers? Aren't those low/good enough to consider a cat regulated?
 
MissyKat said:
Finally found George's ss: I see giving insulin with numbers lower than 100 at PS but the dosage is much lower than 4.5u...I'd feel safer with that small amount probably
Why even give insulin with those numbers? Aren't those low/good enough to consider a cat regulated?
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Your cat needs a larger dose right now. I’m not sure why you feel there’s more of a chance of a hypo with a larger dose. That would only happen if the dose were too high for your cat which it’s not.

If George did not get insulin his bg numbers would go up. They are only in range because he gets his insulin. If you look at his whole 2021/ss you will see how much higher he got when they were on vacation. The goal of TR is for the cat to have normal bg with whatever amount of insulin is needed.
 
Hi MissyKat

you keep asking about the 200 point and think it says not to shoot, maybe you are misunderstanding the word HOLD, they mean keep it at the same dose for x amount of cycles...here is what it says

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.

I hope this helps, maybe that was what you were thinking?
 
MissyKat said:
Finally found George's ss: I see giving insulin with numbers lower than 100 at PS but the dosage is much lower than 4.5u...I'd feel safer with that small amount probably
Why even give insulin with those numbers? Aren't those low/good enough to consider a cat regulated?
Click to expand...
George is regulated. She’s hoping for remission. Once regulated you still need to give insulin.
 
MissyKat said:
So, as I'm still trying to understand how this works, if by increasing to 4.5u at AMPS made the numbers drop that much, how do we know that by shooting another 4.5u at PMPS won't make him hypo?
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I used to think this exact same thing until one of the moderators explained it to me…and I was scared to shoot under 200 until then too! Honestly I was scared to shoot in the 200s because they were so rare for him at the time. I only wish I had started doing it sooner (with the help/guidance of the great people on here of course)…as Elise said, the greens become very addictive.

George was actually on 3ish units when I started shooting lower numbers, and he didn’t start seeing consistently better numbers until I started shooting lower and lower. My recommendation would be to only follow the advice directly from the board because they will get to know your cat and can offer tailored dosing advice and help you through shooting lower and lower numbers. It drives me crazy when people automatically say never to shoot under 200 on Facebook. It’s a general rule for people starting out, but I see it often and wonder if the people saying this are even on the board where they would see that lots of people shoot lower than that safely every day.
 
Hshray said:
I used to think this exact same thing until one of the moderators explained it to me…and I was scared to shoot under 200 until then too! Honestly I was scared to shoot in the 200s because they were so rare for him at the time. I only wish I had started doing it sooner (with the help/guidance of the great people on here of course)…as Elise said, the greens become very addictive.

George was actually on 3ish units when I started shooting lower numbers, and he didn’t start seeing consistently better numbers until I started shooting lower and lower. My recommendation would be to only follow the advice directly from the board because they will get to know your cat and can offer tailored dosing advice and help you through shooting lower and lower numbers. It drives me crazy when people automatically say never to shoot under 200 on Facebook. It’s a general rule for people starting out, but I see it often and wonder if the people saying this are even on the board where they would see that lots of people shoot lower than that safely every day.
Click to expand...
That's exactly how I feel...may take me some time to fully understand the process and I have been following the expert guidance from the people on FDMB but then yet I see a random comment on fb and I feel very insecure again...I think this is just in the beginning but hopefully I'll be more confident soon.
Glad your George is regulated and hopefully in remission soon :bighug:
 
tiffmaxee said:
Your cat needs a larger dose right now. I’m not sure why you feel there’s more of a chance of a hypo with a larger dose. That would only happen if the dose were too high for your cat which it’s not.

If George did not get insulin his bg numbers would go up. They are only in range because he gets his insulin. If you look at his whole 2021/ss you will see how much higher he got when they were on vacation. The goal of TR is for the cat to have normal bg with whatever amount of insulin is needed.
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Thank you, that's what I thought, the larger the dose=higher chance of hypo when BGs are lower...I don't think I fully understand insulin and how it works yet, I'll keep on reading through the guides and files ;)
 
Don’t feel bad. That’s a lot to learn. I wish I knew what I know now when Max became diabetic. :bighug:
 
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