? 08/02 Tommy AMPS 273, +8@185, PMPS 250, 1.25u Ok?

[Tommy_15]

Prior day post:
https://www.felinediabetes.com/FDMB...-274-7-130-pmps-148-dose.266587/#post-2984119

Continuing with 1.25u dose. Still seeing wild swings/rebounds. Should we keep the dose as is for 6 to 10 cycles?

 

[Bandit's Mom]

Should we look into any supplements and if yes, what is advisable?

What supplements do you have in mind?

With the way we are doing testing and dose increases - should this be a TR protocol?

Continuing with 1.25u dose. Still seeing wild swings/rebounds. Should we keep the dose as is for 6 to 10 cycles?

Your Signature and SS says you are following SLGS?

With SLGS you hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90 mg/dl (on a human meter). The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50 mg/dl (on a human meter). The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.

 

[Tommy_15]

What supplements do you have in mind?

I've seen milk of thistle mentioned in the posts to support liver function

Your Signature and SS says you are following SLGS?

Looks as that would be the most manageable option for us. We can do curves over the weekend. Is there stats that outlines a remission success rate for SLGS versus TR?

With SLGS you hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90 mg/dl (on a human meter). The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

the 90 to 150 values mentioned - are these nadir # or target within the cycle range? This is where it is a bit confusing as the SLGS general guidance calls for no shot when preshot is below 150.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50 mg/dl (on a human meter). The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.

Thank you for clarification. Yes, Tommy is on LC canned food diet only with freeze dried treats (chicken, salmon, turkey). He has been on the canned diet mostly anyhow, but there was food with C content past 10%.

 

[Bandit's Mom]

I've seen milk of thistle mentioned in the posts to support liver function

Yes it is.

Looks as that would be the most manageable option for us. We can do curves over the weekend. Is there stats that outlines a remission success rate for SLGS versus TR?

There have been cats who have gone into remission on SLGS but some cats require the aggression and nimbleness of TR.

the 90 to 150 values mentioned - are these nadir # or target within the cycle range? This is where it is a bit confusing as the SLGS general guidance calls for no shot when preshot is below 150.

Those are the nadirs mentioned for SLGS. If you look at the dosing protocols sticky, it addresses how to deal with low preshots when new to insulin and later also for people with more experience. With SLGS you can eventually shoot any number over 90.

 

[Tommy_15]

Yes it is.


Those are the nadirs mentioned for SLGS. If you look at the dosing protocols sticky, it addresses how to deal with low preshots when new to insulin and later also for people with more experience. With SLGS you can eventually shoot any number over 90.

thank you for clarifying 90 to 150 as nadir values. My confusion lays in the "sticky" recommendation " not to dose if preshot BG is <150 and 150-200:

 

[Bandit's Mom]

thank you for clarifying 90 to 150 as nadir values. My confusion lays in the "sticky" recommendation " not to dose if preshot BG is <150 and 150-200:

View attachment 65063

Yes, that is for beginners whose cats are new to Lantus and do not have data on their cats. After that it also says:

"Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Levemir, and Biosimilars users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:

• Do you need to stay on schedule? Then skip the shot.
• Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
• Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.

If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.

We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat."

 

[Tommy_15]

Yes, that is for beginners whose cats are new to Lantus and do not have data on their cats. After that it also says:

"Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat.

That's helpful. Thank you. will have to build up the data to see how Tommy processes insulin. Are there any "typical" indications in kitty behavior at nadir (not hypoglycemic) BG levels, e.g. begging for food, or becoming more active or sleepy, etc?

 

[Tommy_15]

just tested at AM+7, BG is flat from AM level. Seems as a repeat of 7/31 run. Looking for an explanation how can it be a flat curve with insulin injected. Could we possibly injected Lev wrong or the flat curve can be "normal" since kitty are different? The key question in ref to SLGS, do we need to stay a week with the new dose (increased 6 cycles ago by 0.25u from the original 1u) and run a complete midcycle tests in 2 days to get new curve prior to upping the dose again, OR we need to increase the dose right away as soon as we see nadir is not dropping below 150??? PLEASE ADVISE

 

[Bandit's Mom]

will have to build up the data to see how Tommy processes insulin.

Yes, you also want to get a before bed test because many cats go lower at night. Getting tests only in the day gives you half the picture.

Are there any "typical" indications in kitty behavior at nadir (not hypoglycemic) BG levels, e.g. begging for food, or becoming more active or sleepy, etc?

Cats do tend to get hungry and beg for food when they are dropping low or dropping fast. So whenever he does that, you want to get a test to see where his BG is at. Till their body gets used to lower numbers, they can be sleepy or tired in normal numbers. It's like a coffee addict without caffeine. Once they get used to normal numbers they love them and become active and playful again.

just tested at AM+7, BG is flat from AM level. Seems as a repeat of 7/31 run. Looking for an explanation how can it be a flat curve with insulin injected. Could we possibly injected Lev wrong or the flat curve can be "normal" since kitty are different?

With Levemir the onset and nadir are later in the cycle. You want to figure out when those are for Tommy by getting some more data. In cycles where they are bouncing, numbers can be flat and high. Almost like they are not getting enough insulin.

The key question in ref to SLGS, do we need to stay a week with the new dose (increased 6 cycles ago by 0.25u from the original 1u) and run a complete midcycle tests in 2 days to get new curve prior to upping the dose again, OR we need to increase the dose right away as soon as we see nadir is not dropping below 150??? PLEASE ADVISE

With SLGS you need to hold a dose a week. Even if the numbers are not in the range you want them to be. With TR you can increase as often as every 3-5 days.

IS TIGHT REGULATION POSSIBLE WITH A FULL TIME JOB? YES!

 

[Tommy_15]

With SLGS you need to hold a dose a week. Even if the numbers are not in the range you want them to be. With TR you can increase as often as every 3-5 days.

IS TIGHT REGULATION POSSIBLE WITH A FULL TIME JOB? YES!

Bhooma, thank you so much for your responses and guidance. TR will be a stretch as it appear requiring a lots of testing. We can do midcycle testing over the weekend only. Midweeks are a bit crazy but can try to do testing between +7 and +10 if this would come handy.

a few more questions please:
- we planned 4 days vacations a year ago. it is scheduled late in August. Any suggestion on how to handle this situation? We can have someone feeding kitty twice a day, but this person would not be able to do shots or testing.
- if milk of thistle is helpful supplement, what dose and form it needs to be in?

 

[Bandit's Mom]

- we planned 4 days vacations a year ago. it is scheduled late in August. Any suggestion on how to handle this situation? We can have someone feeding kitty twice a day, but this person would not be able to do shots or testing.

You want to check back here 4-5 days before you go on vacation for the vacation dose. The vacation dose is determined based on the then current dose and how the cat is faring on the dose. Things can change between now and a couple of weeks from now.

- if milk of thistle is helpful supplement, what dose and form it needs to be in?

I've not used milk thistle. I was thinking of giving it to Bandit but didn't get around to it. I am not familiar with the dosage. Here's some info that I unearthed from google when I had looked for the dosage!

"For pills or powder start with about 10mg per 1kg of body weight"
https://authenticapets.com/en/blog/milk-thistle-for-cats-dogs

"The standard dosage of milk thistle seed extract is based on a silymarin content of around 80 percent; most supplements contain anywhere from 50-500 milligrams (175 mg is typical). Because of its excellent safety record and lack of adverse drug interactions, when I’m treating a very sick animal with advanced liver disease, I do not hesitate to use the full human dose–up to 200 mg per 10 pounds of body weight–of milk thistle extract daily. For most purposes, however, one-third to one-half of that dose is more than adequate."
https://littlebigcat.com/milk-thistle-a-wonder-herb/

"The dosage is decided on the basis of silymarin content. In case of cats, a single extract or powder capsule of 100 mg strength is used daily. This dose is for cats with a body weight of around 10 pounds. This dosage may be increased slightly for larger cats and those with severe liver problems. On the other hand, the dosage will be reduced for cats with a body weight less than 10 pounds. In case of tablets with a strength of 250 mg, half a tablet will be sufficient"
https://catappy.com/milk-thistle-dosage-for-cats

 

[Tommy_15]

You want to check back here 4-5 days before you go on vacation for the vacation dose. The vacation dose is determined based on the then current dose and how the cat is faring on the dose. Things can change between now and a couple of weeks from now.

Does vacation mean someone else need to do shots twice a day but without testing?

I've not used milk thistle. I was thinking of giving it to Bandit but didn't get around to it. I am not familiar with the dosage. Here's some info that I unearthed from google when I had looked for the dosage!

Thank you for the information on this supplement. I thought about one in liquid form but scratched it out as it contains vegetable glycerin which appears to be a sugar like syrup.

 

[Bandit's Mom]

Does vacation mean someone else need to do shots twice a day but without testing?

Yes, some people can only find sitters to give the shots but can't test. So we recommend a lower dose especially for tightly regulated cats seeing low green nadirs.

 

[Tommy_15]

will have to look for options available prior to vacation.
I posted some questions in my daily post. Hope to get some guidance.
https://www.felinediabetes.com/FDMB/threads/8-4-tommy-amps-149-6-266-12-320.266679/