Mister's dosing

MisterBillie

MisterBillie

Member
Continuing from the discussion in my first thread here:
https://www.felinediabetes.com/FDMB/threads/new-member-wet-food-feeding-guide-4-cans-a-day.257824/

Today in his AMPS @ 1.5u, he tested at 341. I finally got around to doing a midday test which was recommended by @FrostD and it was 322 @ +6hrs. This leaves me more questions than answers TBH.

His appetite is way down today. He even threw up a little bit of his food and is lethargic. I still haven't figured out how to get him to eat 5 cans a day (his weight is 17lbs). At this point, 3 cans is the most I can get him to eat and that's a good day.
 
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Three cans is not bad, although with his size (he's 17 lbs??) he could eat more. You do not have to wait until he's finished eating to give the insulin. You test, feed/shoot... which can be done simultaneously.... the shooting and eating part :-) That's what I always did. Usually shot while he was eating or, if I knew he was hungry, I just went ahead and shot then gave the food... but it was super easy to shoot while he was eating.
 
A few more cycles and you will be able to increase, most likely, unless by some chance he starts to go lower. Maybe tomorrow you can try to get a +4 test to see what's going on there. It would be nice to know when the insulin onsets (starts to reduce the BG) because right now you can't tell! He is so flat in his numbers! I'm sorry! Hang in there.
 
Suzanne & Darcy said:
A few more cycles and you will be able to increase, most likely, unless by some chance he starts to go lower.
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Hmm, I was hoping I wouldn't have to increase the dose.
Suzanne & Darcy said:
Maybe tomorrow you can try to get a +4 test to see what's going on there. It would be nice to know when the insulin onsets (starts to reduce the BG) because right now you can't tell! He is so flat in his numbers! I'm sorry! Hang in there.
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That was my thoughts as well, and also what @FrostD recommended where he wagered that he nadirs around +4 or 5. So maybe tonight and tomorrow I will try to get a +4 test.

Also, here is my process so far:
  1. Feed him just before the 2hrs mark before preshot. He then fasts until Step 3.
  2. AMPS (AM preshot): Preform a Blood Glucose (BG) test
  3. Immediately after Step 2, feed him a 1/2 can (he usually doesn't finish it, only eating half of it just licks the fluid up mostly).
  4. Administer insulin @ 1.5u of ProZinc while he has just begun eating from Step 3.
I just hope that he's eating enough in Step 3 to even fill his stomach enough to count as "eating". Also, it's good to know that I don't have to wait longer between Step 3 and Step 4 by the sound of it.
 
MisterBillie said:
Hmm, I was hoping I wouldn't have to increase the dose.

That was my thoughts as well, and also what @FrostD recommended where he wagered that he nadirs around +4 or 5. So maybe tonight and tomorrow I will try to get a +4 test.

Also, here is my process so far:
  1. Feed him just before the 2hrs mark before preshot. He then fasts until Step 3.
  2. AMPS (AM preshot): Preform a Blood Glucose (BG) test
  3. Immediately after Step 2, feed him a 1/2 can (he usually doesn't finish it, only eating half of it just licks the fluid up mostly).
  4. Administer insulin @ 1.5u of ProZinc while he has just begun eating from Step 3.
I just hope that he's eating enough in Step 3 to even fill his stomach enough to count as "eating". Also, it's good to know that I don't have to wait longer between Step 3 and Step 4 by the sound of it.
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I would just make sure he is actually eating when I give the insulin. I am sorry his appetite is not great. I sure hope it's just that he feels lousy from the high numbers and that he will feel better soon!
 
What did your vet say about the blood work you had done? She/He wasn't concerned about the values that were out of range? Also, what about the protein in the urine and the red blood cells?
 
MisterBillie said:
Hmm, I was hoping I wouldn't have to increase the dose
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Well, his numbers are too high right now so, if he doesn't start coming down, that's the road ahead. Sorry. Of course, it has to be done safely according to the protocols to keep your dear boy safe! All cats are different and they need however much insulin they need. Some cats on this board get one drop. Some cats get a LOT of units. My cat was over 40 units at one point.. but don't worry about that, he had Acromegaly and so had a "high dose condition." The point is, we need to find out how much he needs. And, having said that, a cat's insulin needs can and do change... that's why it's called the "sugar dance."
 
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I am not seeing tests today except AMPS? Definitely do not increase by more that .25 units. But we need more data to see how low this dose is taking him. I know you can do it!
 
Suzanne & Darcy said:
I am not seeing tests today except AMPS? Definitely do not increase by more that .25 units. But we need more data to see how low this dose is taking him. I know you can do it!
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Yeah I was super busy today, I will do two tonight after the PMPS hopefully. I'll aim for a +2 and then a +5 maybe.

I am now able to use the 30ga lancet instead of the 26ga. Hopefully this will reduce the pain for the cat.
 
MisterBillie said:
Yeah I was super busy today, I will do two tonight after the PMPS hopefully. I'll aim for a +2 and then a +5 maybe.

I am now able to use the 30ga lancet instead of the 26ga. Hopefully this will reduce the pain for the cat.
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That’s great. I used the 30 gauge lancets free hand. Much smaller. You must be getting good!
 
I just did a +2.5 after the AMPS and it was higher than the AMPS.

How is that even possible?! This is super disheartening. It's almost like it's saline, not insulin.

I can try another test in two hours, but I see no reason why it'd be a lower number.
 
That is likely meter variance, we consider that flat actually. 20% variance for human meters, 15% for pet meters. So actually you just caught onset; they usually get a BG bump from the carbs they eat at AMPS, then the insulin kicks in and starts to lower. Guessing onset is about +2
 
FrostD said:
That is likely meter variance, we consider that flat actually. 20% variance for human meters, 15% for pet meters. So actually you just caught onset; they usually get a BG bump from the carbs they eat at AMPS, then the insulin kicks in and starts to lower. Guessing onset is about +2
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Ok, so shall I try a +3 or +3.5 then tonight. Or what is the next best step.
 
Suzanne & Darcy said:
Yes. I would try a +3 or +4. How is it going with the testing?
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Good, my cat now waits in the designated staging area for the BG tests, lol. Here I thought he'd be hiding from me prior to the tests, turns out it's the complete opposite. He meows and wakes me up and leads me to the testing area now.

The main problem I am having is that he typically will only eat a 1/4 can or less of a 3oz small can in a given sitting, which makes feeding him a full time job. That means I have to feed him like 12 times a day or more. Likewise, this makes it hard to do multiple tests in a day because of the requirement of the cat having to fast 2hrs prior to testing. So the more instances of him being fed, the more potential BG test windows he ruins. The annoying part is that he still isn't eating even close to as much as he should be according to Fancy Feast's feeding guide (he should be eating 4-5 cans a day, but he's only eating less than 3).

His urine clumps in the litter box is like glue, I am going to need to use a high end scooper made of metal (let me know if anyone has suggestions) to pry these clumps from the sides of the litter box. So far it does not appear the insulin is doing anything as far as I can tell. I might have to force him to fast so that I can have more testing windows.

Overall, I wouldn't wish this situation on my worst enemy. "Sleeping in" is a thing of the past now. I have yet to have an uninterrupted sleep cycle since his diagnosis. I will never be able to go on vacation or do weekend cabin trips. I might as well sell all my sporting equipment. At this point, I would literally rather have myself be diabetic instead of my cat having diabetes
 
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What kind of kitty litter are you using. I have a LOT of suggestions. If you want a dust free litter that doesn’t turn into sludge, try:
https://www.chewy.com/garfield-cat-litter-super-clump/dp/147769#pdpGallery

Garfield cat litter clumps fast and like a rock! But it will track like samd.

Another great, very dust-free litter is Grass Litter. Either Pioneer Pet Smart Cat Litter or Chewy’s Frisco version (are you in Camada? Sorry because Chewy doesn’t ship to Canada.).

https://www.chewy.com/pioneer-pet-s...erm=4584688617261494&utm_content=All Products


These two litters are the best clumping litters that I have used. I have/ have had a zillion cats so I have tried sooo many.
 
@Suzanne & Darcy Dr. Elsey's Ultra Cat Litter. I've never had an issue with this litter until very recently. I think it's due to diabetes, it causes sugar in the urine and makes it like glue. I think this problem will occur with any litter until I can figure out how to get insulin to actually work.

Good to know on the iPrimio scooper being good, that was the one I had in my cart on Amazon and was about to order.
 
I threw my ReliOn Premier Blu as hard as I could against the wall today during the PMPS in anger. Kept getting Er4 three times in a row when it wicked up the blood drop, never had that issue before until now.

None of my BG tests are telling me anything useful. I might as well be injecting saline and pricking my cat's ear for no reason whatsoever, the result would be the same.

Time to shop for a new meter. I wish they made one that also could test ketones at the same time. Or maybe I should just get the Alphatrak 2
 
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Ah, not enough blood. It happens!

The insulin is working, he just needs a higher dose. Patience.

You listed SLGS on spreadsheet, per that method you would hold the dose for a week or until you can do a full curve (test every other hour for 12 hrs). If you can get 4 tests in per day - the 2 preshots, plus one more in each cycle - you could follow the MPM which allows for faster increases. Ideally, those other tests would be close to nadir. Per MPM you could increase as soon as tomorrow, if you have a meter. With MPM we don't reduce until they go below 50, but in your case I wouldn't recommend that. I would follow MPM til he gets in a better BG range, figure out what you're comfortable with in terms of BG, and switch back to SLGS if needed.

I wouldn't waste your money on AT. There are several meters out there that use the same sample size (0.3uL) which may make things easier - NovaMax Plus being one of them. It's 0.3uL for BG, 0.8uL for ketones. Those ketone strips are even more painful to waste, but BG strip cost not bad.

Were you the one that said you're a network guy? I did fair amount of industrial Ethernet back when I was working - you have to put the overly analytical part of your brain aside for a bit. The meters have error, it sucks, but you'll go crazy overanalyzing every little thing - "is it 300? Or is it 240? Or 360?". Doesn't matter. The trends are what you want to look at. High is high, he needs more insulin - ultimately that's the conclusion that matters.
 
FrostD said:
You listed SLGS on spreadsheet, per that method you would hold the dose for a week or until you can do a full curve (test every other hour for 12 hrs).
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I am not sold on SLGS by any means, that's just the first method I've come across so far. So as soon as tomorrow, I can try a +2, +4, +6, +8, and +10 test all in one 12hr period? AM or PM? Jesus, my cat is going to hate me. This is going to be terrible.

FrostD said:
If you can get 4 tests in per day - the 2 preshots, plus one more in each cycle - you could follow the MPM which allows for faster increases. Ideally, those other tests would be close to nadir. Per MPM you could increase as soon as tomorrow, if you have a meter. With MPM we don't reduce until they go below 50, but in your case I wouldn't recommend that. I would follow MPM til he gets in a better BG range, figure out what you're comfortable with in terms of BG, and switch back to SLGS if needed.
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I did the 4 tests per day on 1/18 through 1/20. The data didn't tell me anything other than I might as well be injecting saline. What is "MPM"?

FrostD said:
Were you the one that said you're a network guy? I did fair amount of industrial Ethernet back when I was working - you have to put the overly analytical part of your brain aside for a bit. The meters have error, it sucks, but you'll go crazy overanalyzing every little thing - "is it 300? Or is it 240? Or 360?". Doesn't matter. The trends are what you want to look at. High is high, he needs more insulin - ultimately that's the conclusion that matters.
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No, that was someone else. I have yet to find a nadir. I would wager there is no nadir to find, this insulin is defective or I must be choosing precisely the exact wrong window to be testing each day. I do not see an actionable solution or a path forward to get these numbers down, other than just blindly upping the dose while I have yet to witness a nadir.
 
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Few things:
The 4 tests would have to be each day.

I wouldn't bother him with a curve. I would just try for +4 and +5 tests right now.

You usually test at +2, that's often onset - when the insulin is just starting to work. Of course you're not going to see much difference there, just because of the way insulin works. Nadir is usually +4 to +6. The +6 you got a few days ago tells me nadir is before that. The +3 you got in a PM cycle was a good drop, which is why I wage nadir is +4 or +5 - but you haven't gotten those tests yet.

Here are the two dosing methods: https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

Quick summary:
*Remission is achieved when they are in mostly normal numbers, so 50-99 on human meter, with no insulin. So you slowly work your way down as their pancreas heals and requires less insulin.

SLGS does reductions under 90; requires you to hold a dose for a week then do a curve. This isn't in the official method, but I personally "accept" scattered test data over 2-3 days in lieu of a curve. Advantage is usually less testing, less intervention with higher carb food when they get into lower numbers. Disadvantage is holding a dose long time while in higher numbers, low chance of remission.

MPM you cannot give any dry food. Reductions under 50. But because it allows their BG to go that low, you have to test more to keep them safe. It has better chances at remission, allows for faster increases.
 
FrostD said:
The +3 you got in a PM cycle was a good drop, which is why I wage nadir is +4 or +5 - but you haven't gotten those tests yet.
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I did a +4 during the PM cycle just now. It was 268... So again, the data seems to suggest the insulin isn't doing anything. So I guess I have to try +5 during another cycle because I feed him after tests. Should I just jump to 2 units tomorrow or stick with 1.75F and do a +3 and a +5 tomorrow?
 
Been on 2.25U for a few days now, not seeing any progress. His numbers are getting worse.

Going to up to 2.5U tomorrow and do more testing.
 
You do not have enough midcycle tests to know how low the dose is taking him. If you can't test during the day, then you'll want to do a curve before considering an increase.

Numbers are about the same considering meter variance, I wouldn't consider them worse
 
FrostD said:
You do not have enough midcycle tests to know how low the dose is taking him. If you can't test during the day, then you'll want to do a curve before considering an increase.

Numbers are about the same considering meter variance, I wouldn't consider them worse
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What tests should I do today so we have a curve? +3, +5, +7?
 
FrostD said:
Sorry I missed this, but yes a curve is every other hour for 12 hours, or every 3 hrs for 18 hrs
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Testing has commenced. It's looking like his "nadir" is late... The +9 will be lower than the +7 if this trend continues, I will know more in 2hrs.

Also, by definition there's no way to get him tested exactly every two hours, because it takes 15 mins after the BG test for him to eat. So the +4 becomes a +4.25, and the +6 becomes a +6.5, etc.
 
Hmm, just as I thought. There really isn't a curve. He's stuck in a state of hyperglycemia. Should I even bother with a +11?

I can already see the pain in his back legs getting worse day by day.

Is this glucose toxicity? Should I up the dose even more for the PMPS? SLGS is not working at all, if anything this is the exact wrong approach. Wasn't it Dr. Lisa who said to use a unusually large dose to knock them out of a state of glucose toxicity?

Should I switch to Lantus? Does anyone know the name of that cat only vet in Cali that claimed 80% remission rates? I might need to reach out to them to see what I'm doing wrong.
 
I don't see why you're calling it flat. There is a curve, and actually a nice flatter one. Much better for the cat than wild swings. I would increase another 0.25U.

Nothing says you have to stick with SLGS. You an change at any time, provided he's completely low carb wet diet and you can do the requisite extra testing.

Beware quack vets. We're lucky if 1 cat a month goes into true remission here. Many of those vets call remission anything under 150 and do not properly titrate the dose down. What they don't tell you is those cats end up relapsing.

He's getting nice curves on ProZinc, I wouldn't switch yet, but also no harm in switching. But Lantus is not great at pulling down higher nunes, it's better at keeping low numbers low. So it may take you a little longer to break through toxicity.

A one time large dose is not wise. You run a very serious risk of a hypo event, and odds are he's just going to bounce sky high after...that shock to his system will make his liver panic and dump stored glycogen and hormones into his system, and the cycles continues
 
FrostD said:
A one time large dose is not wise. You run a very serious risk of a hypo event, and odds are he's just going to bounce sky high after...that shock to his system will make his liver panic and dump stored glycogen and hormones into his system, and the cycles continues
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How do I know this already isn't happening? I'm not sure why +1 is even on the spreadsheet, no one can perform a +1 or +1.5 test given the restriction of not being able to feed the cat 2hrs prior to testing. If he's going hypo @ +1 or +1.5 there's no way to know.

Edit: I just did a full 24hr curve. Now we have the data. What now, should I up the dose to 3u tomorrow? Or go to the vet to see if another underlying issue is causing the insulin to not work?
 
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MisterBillie said:
How do I know this already isn't happening? I'm not sure why +1 is even on the spreadsheet, no one can perform a +1 or +1.5 test given the restriction of not being able to feed the cat 2hrs prior to testing. If he's going hypo @ +1 or +1.5 there's no way to know.

Edit: I just did a full 24hr curve. Now we have the data. What now, should I up the dose to 3u tomorrow? Or go to the vet to see if another underlying issue is causing the insulin to not work?
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So I just want to clarify - you don't have to withhold food for midcycle tests. Only the preshots so you have a consistent number to base decisions on.

Again, the insulin is working. The dose just isn't high enough yet, but you need to be patient and give him a few cycles to see how the dose works for him. Like yesterday you increased to 2.5 and then 2.75, you need to stick with it and not change it. Give him 3 days minimum at 2.5U, then consider an increase...but again you need midcycle tests, I'd be aiming for +5 or +6 if you can.

You just need to hit a breakthrough dose to get through the glucose toxicity, once that happens he should start to come back down in dose. There is always a chance there's an underlying condition causing insulin resistance, but we don't recommend those tests until they hit 6U (most vets won't run them til they hit 2U/kg)
 
FrostD said:
So I just want to clarify - you don't have to withhold food for midcycle tests. Only the preshots so you have a consistent number to base decisions on.

Again, the insulin is working. The dose just isn't high enough yet, but you need to be patient and give him a few cycles to see how the dose works for him. Like yesterday you increased to 2.5 and then 2.75, you need to stick with it and not change it. Give him 3 days minimum at 2.5U, then consider an increase...but again you need midcycle tests, I'd be aiming for +5 or +6 if you can.

You just need to hit a breakthrough dose to get through the glucose toxicity, once that happens he should start to come back down in dose. There is always a chance there's an underlying condition causing insulin resistance, but we don't recommend those tests until they hit 6U (most vets won't run them til they hit 2U/kg)
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Great info as usual, thanks

Looks like I will be going to 3u tomorrow. Seeing that 190 after a full day of doing curves was very frustrating. Never saw blue again after that.
 
On to 3.25u. This is beyond frustrating at this point.

I'm beginning to think the vet's method of just blindly saying do "X units" where X is a large number is the way to go. I'd rather flirt with hypo, which is controllable and immediately solvable, than drown my cat in sugar for months with SLGS. If anything, SLGS is BUFFING/strengthening his glucose toxicity.

Is there any scientific data to back that SLGS is better than any other method? Which vets endorse SLGS?

I'm think I'm gonna do 0.5 increments from here on out, there's no reason not to. I don't see why I would waste time doing 0.25 increments over 0.5 increments. In fact, I might even do 1u increments if this thing really starts going past 4u. How else am I going to break through the glucose toxicity?

Unless you're testing every hour in perpetuity, you can never know for a fact that you've not missed a nadir.
 
You're not really following either method. I hear your frustration, and honestly I'm not sure how much more we can do for you. Need a big pair of patience pants!

You are increasing faster than SLGS is written, not getting curves. You can follow MPM for faster and possibly larger increases (0.5U until he's seeing blue, re evaluate every 3 days), but honestly you're not getting enough tests during the day. Youd need at least one during the day, ideally before +5.

Most people in your situation I advise to start with MPM, do the grunt work of extra testing up front to get them into better numbers more quickly. Then once they're there, SLGS is often a better option for most people.

All I can do is give guidance based on how the protocols are written and the experience I have with cats here. If you choose not to follow it, then unfortunately there's nothing more I can do to assist. I don't mean that any particular way, it's just facts and forum rules. You are always more than welcome to do what the vet wants you to, you know the risks. The problem is no, hypos are not always controllable and easily solvable. Without tests, you have no idea how low he's going and you may not catch it. Hypos can drag out, we've had cats seize for 8 hours straight. We've had cats die. We've had cats paralyzed, left blind. And none of that was due to advice here - that was by too large of doses and lack of monitoring. It's not fear mongering, I just want to make sure you know that it's not that simple.
 
You don't need to know exact nadirs you just need to have enough data to make a reasonable inference.. Also, above 5U we do larger increases, we usually aim for increases being about 10% of the dose.

Nobody has claimed SLGS is better than another method. In fact, I'm sure we've mentioned that it can take longer to get into better numbers.

Most vets follow the AAHA guidelines (here's a flowchart), I'm sure you'd find those not exactly satisfactory either. Anything under 300 considered good glycemic control . Doses held for 7-15 days, then a curve. Nadir 80-150, hold the dose. Greater than 150+ no clinical signs, hold for 1-3 months. Clinical symptoms, increase by 0.5-1U and recheck in another 1-2 weeks.

So, do with that what you will. But in my opinion when seeing a nadir from 150-200, increasing the dose by anything more than 0.5U is a recipe for trouble. It will also exacerbate bouncing in many cases.

Now if you read the ProZinc insert, they did a study of 176 cats. 71 of whom had hypoglycemic episodes (BG less than 50 and symptomatic - dazed, lethargic, weak). They did another study, 145 cats, 20 had symptomatic hypos. 3 had serious hypos, two of whom died.

All any us can do is what we think is best for us, our cats, and our situation. We've educated you on how this forum does things; other groups, other vets, etc will all recommend slightly different things.
 
Okay, I will follow MPM then. But unlike SLGS, the MPM guide is incredibly poorly written. What exactly is the difference between it and SLGS. It says "if you started with SLGS and switch to the modified method, please skip to “Changing the Dose” below", does that mean everything that you skip is to be ignored and instead you follow everything in SLGS plus what is mentioned in "Changing the Dose" under MPM?

I was about to create a flowchart of MPM, but I just noticed MPM cannot actually be flowcharted because it contains logical inconsistencies. For example, observe these four bullet points
  • In general, dose changes are made in increments of 0.25u. In sensitive cats, it may be necessary to make even smaller changes.
  • If a cat is having nadirs above 200, then dose changes of 0.5u are recommended.
  • Occasionally we see cats who need the dose held longer than the recommended 3-6 cycles because they are very prone to diving BG numbers or bouncing. Collecting data and learning your cat’s patterns are essential to determining if your cat might be in this category.
  • Conversely, holding the dose for too long can lead to glucose toxicity - when the blood glucose gets “stuck” and even increasing seems to do nothing. If this happens, seek advice on next steps.
It is impossible to satisfy all of those. Bullet point #1 recommends considering 0.25 or even smaller changes. Then bullet point #2 says 0.5u changes are recommended for cats with nadirs above 200. Which is it? How do I know that the high nadirs aren't caused by 0.25u changes being too excessive? It's not clear if 0.15u or 0.5u is more appropriate for a cat with high nadirs. Likewise, the last two bullet points are completely contradictory as well. Regarding the third bullet point, how do I tell if my "cat might be in this category"? By opting for bullet point #3, it will likely cause bullet #4 to happen. And vice versa regarding bouncing.

The AAHA flowchart is very clear and I can definitely follow that. MPM is not written well enough to be logically applicable. If someone can work with me and explain MPM in a logical way, I will flowchart MPM and share it here. Until then, all I see when I read MPM is a wall of text with contradictions and ambiguities.

I can test as often as needed. I already did a full 24hr curve, which really didn't reveal anything useful other than no progress is being made. Then I reverted back to doing midcycle tests, all of which are just high 200-300 range. So to do more 12hr or 24hr curves is not going to yield anything useful on these little baby 0.25 increases.
 
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FrostD said:
You can follow MPM for faster and possibly larger increases (0.5U until he's seeing blue, re evaluate every 3 days), but honestly you're not getting enough tests during the day. Youd need at least one during the day, ideally before +5.
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Yes, lets go with this idea then. But again, MPM does not explicitly state how often and when to test. Terms like "at least one" and "ideally" doesn't compute for me. I missed a couple days there as you allude to, otherwise I have been testing him "at least once".

I just read MPM like 4 times in a row. The more I read it, the less it makes sense. MPM says you can hold subsequent doses after the initial dose for 3-6 cycles (1.5-3 days). To increase the dose, it also requires that you know "How low has the current dose taken kitty over the last 72 - 96 hours" (3-4 days), which is impossible unless your cat fasts the entire curve and you do a full 24hr curve the entire time for those 4 days. Does that mean I have to wait the 1.5-3 days and then do curve testing for an additional 3-4 days in a row, or can these windows overlap? Lastly, to increase the dose by 0.5u or less, MPM says I need to do (5 tests in a curve)*(4 days)*(2 curves in a day) = 40 tests before each 0.5u increase?!

MPM should be rewritten to be more explicit. An unordered list is an unacceptable format for something like this. For starters, during that non-curve window of 1.5-3 days, exactly when should I test him and how often? I can test him anytime and any frequency. If I test him at +2 and +4 and see high numbers, then anyone could argue that I missed a nadir at +3 or +5 or +6 or +7. If I test him at +6 and see high numbers, then how do I know the nadir didn't happen at +2, +3, +4, or +5? With these mid-cycle tests, the takeaway seems to be that I'm never picking the correct window. If I pick +4, then I shoulda picked +7 in hindsight. Now that I'm doing +5 and +7 tests, now I need to go back to something before +5?

Does anyone have an example spreadsheet of someone successfully using MPM on a cat that achieved remission? Maybe I can reverse engineer MPM via their spreadsheet to make it make sense to me.
 
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