? Noah dosage suggestion

[stefania - Noah]

Hello

it’s been now 1 years that I’m trying to regulate my cat but didn’t happen yet… I’m following TR (being reduce the dose just when I’m in holiday and have the pet sitter taking care of him to avoid hypo with her)

I’m
Not sure if I’m doing something wrong or maybe TR method is not working for him. I have being giving him as well b12 supplement for cats to boost his immunity system .

Waiting if someone of you can maybe guide me or suggesting another approach to get him regulated

thanks

 

[Wendy&Neko]

At the one year anniversary of diagnosis, a kitty is considered to be a long term diabetic. You have a few weeks yet, but when that happens, the reduction point changes with TR. Instead of 50, the reduction point becomes 40. For people who have cats that don't hold reductions well and are using the three times on separate days between 40 and 49 rule, they can continue to follow that as a reduction criteria. Plus the week in solid green is also meets the reduction criteria.

Could you mark on the spreadsheet (remarks columns is good) when you got back from holiday? I'm guessing it was the 15th? Another spreadsheet housekeeping thing is the US tab on the spreadsheet. Although I "speak" World tab (in Canada), a lot of the people who help with dosing do not. The US tab cannot translate what is in the World tab if you have something other than a simple number in the cell. In that case, you have to go over to the US tab and manually make the change yourself. An example is August 8th PM cycle, where he earned a reduction, but it just shows as #VALUE on the US tab. You don't need to go back and change all of them now, but doing that going forward, especially with numbers that influence dosing will help us help you faster.

I have a couple suggestions, based on looking at the spreadsheet, of things you can do moving forward, even before the 1 year annifursary. First of all, I see there are a number of nights where you aren't able to get a second test after PMPS. Is this something you can do going forward? Without that, you cannot follow TR. It is those second tests each cycle that answer the question "how low is this dose taking my cat?" With the answer to that question, you can follow TR and be more aggressive about increases. Which is what you need to be if you want to get him regulated. Letting him linger too long in higher numbers hurts the pancreas healing process. If you aren't seeing anything below 200, increase after six cycles (if you get those PM tests too). If you are seeing nadirs in the 100's, and they are still high 100's, you can also increase after six cycles. If they are mid 100's you can stretch it out a couple cycle, and maybe 10 cycles for very low 100's. You held the 0.75 units dose for 16 cycles, but missed second tests for 6 of those cycles. I still wouldn't have waited that long to increase.

Another suggestion deals how you dose if he's not eating well. Insulin does more than just helping balance the carbs in his food. Typically cats that are getting anaesthesia can get a half dose, when they are not allowed to eat. So instead of skipping if he's not eating, consider a half dose, or trying to assist feed if he will let you. Especially when he's in high numbers.

 

[stefania - Noah]

At the one year anniversary of diagnosis, a kitty is considered to be a long term diabetic. You have a few weeks yet, but when that happens, the reduction point changes with TR. Instead of 50, the reduction point becomes 40. For people who have cats that don't hold reductions well and are using the three times on separate days between 40 and 49 rule, they can continue to follow that as a reduction criteria. Plus the week in solid green is also meets the reduction criteria.

Could you mark on the spreadsheet (remarks columns is good) when you got back from holiday? I'm guessing it was the 15th? Another spreadsheet housekeeping thing is the US tab on the spreadsheet. Although I "speak" World tab (in Canada), a lot of the people who help with dosing do not. The US tab cannot translate what is in the World tab if you have something other than a simple number in the cell. In that case, you have to go over to the US tab and manually make the change yourself. An example is August 8th PM cycle, where he earned a reduction, but it just shows as #VALUE on the US tab. You don't need to go back and change all of them now, but doing that going forward, especially with numbers that influence dosing will help us help you faster.

I have a couple suggestions, based on looking at the spreadsheet, of things you can do moving forward, even before the 1 year annifursary. First of all, I see there are a number of nights where you aren't able to get a second test after PMPS. Is this something you can do going forward? Without that, you cannot follow TR. It is those second tests each cycle that answer the question "how low is this dose taking my cat?" With the answer to that question, you can follow TR and be more aggressive about increases. Which is what you need to be if you want to get him regulated. Letting him linger too long in higher numbers hurts the pancreas healing process. If you aren't seeing anything below 200, increase after six cycles (if you get those PM tests too). If you are seeing nadirs in the 100's, and they are still high 100's, you can also increase after six cycles. If they are mid 100's you can stretch it out a couple cycle, and maybe 10 cycles for very low 100's. You held the 0.75 units dose for 16 cycles, but missed second tests for 6 of those cycles. I still wouldn't have waited that long to increase.

Another suggestion deals how you dose if he's not eating well. Insulin does more than just helping balance the carbs in his food. Typically cats that are getting anaesthesia can get a half dose, when they are not allowed to eat. So instead of skipping if he's not eating, consider a half dose, or trying to assist feed if he will let you. Especially when he's in high numbers.

Hello Wendy
Thank you so much for your message!
So practically after one year the approach you take is even more hard with dosage ?
Yes I notice that he doesn’t receive increase very well and he bounce up and down so much …
So I guess now he earn a reduction not on 50 but on 40 , I understood that

I didn’t understood this phrase
“For people who have cats that don't hold reductions well and are using the three times on separate days between 40 and 49 rule, they can continue to follow that as a reduction criteria. Plus the week in solid green is also meets the reduction criteria.”

and also he is considered long term diabetic mean for me to drop the idea of seeing him in remission? Am I correct ?

regarding the night where I didn’t took his test we’re night were I would be exhausted and taking care of my sleep, we all try our best

Regarding the slip I did when he was not eating I took that approach as I finish up to the vet one night as he was in super hypo and I got sooo scared of that that I didn’t felt to take that responsability seeing how bad he react and how sensitive he is with insuline

but of course I’m here to learn as well and I guess my lesson is to be less afraid and start to be more aggressive with dosage and have more commitment to take nadir during the night as well. for example now it’s 2 in the night here and he wake me up as he was crazy askying for food and he was just 9.2… I notice that every time he drop under 10 he freak out and crave food as he is like not used to those “low” number

everything is very frustrated for me and of course I wish more than ever to see him regulated !!! thanks again for your help! @Wendy&Neko

 

[Wendy&Neko]

I didn’t understood this phrase
“For people who have cats that don't hold reductions well and are using the three times on separate days between 40 and 49 rule, they can continue to follow that as a reduction criteria. Plus the week in solid green is also meets the reduction criteria.”

and also he is considered long term diabetic mean for me to drop the idea of seeing him in remission? Am I correct ?

Whether a cat is newly diagnosed, or a long term diabetic, a caregiver can find that their cat doesn't hold reductions well. Meaning that they are constantly reducing, failing the reduction, then going back up in dose again. Down and up over and over. People who have a cat that doesn't hold reductions well can chose an alternate way for their cat to earn a reduction, which is for the cat to go between 40 and 49 on three separate days. Note, going under 40 would automatically earn a reduction.

We still see some cats over a year diabetic go into remission, but it's harder. The first goal is to get them regulated. It's a prerequisite of remission. So focus on regulation first.

for example now it’s 2 in the night here and he wake me up as he was crazy askying for food and he was just 9.2… I notice that every time he drop under 10 he freak out and crave food as he is like not used to those “low” number

Unfortunately, it doesn't seem to take long for their little bodies to feel comfortable in higher numbers again. With vacation, then catching up in dose, it's been a while since he saw normal BG numbers. I'm glad you are increasing now though, that will help him see more of those good numbers and get used to them again.

 

[stefania - Noah]

At the one year anniversary of diagnosis, a kitty is considered to be a long term diabetic. You have a few weeks yet, but when that happens, the reduction point changes with TR. Instead of 50, the reduction point becomes 40. For people who have cats that don't hold reductions well and are using the three times on separate days between 40 and 49 rule, they can continue to follow that as a reduction criteria. Plus the week in solid green is also meets the reduction criteria.

Could you mark on the spreadsheet (remarks columns is good) when you got back from holiday? I'm guessing it was the 15th? Another spreadsheet housekeeping thing is the US tab on the spreadsheet. Although I "speak" World tab (in Canada), a lot of the people who help with dosing do not. The US tab cannot translate what is in the World tab if you have something other than a simple number in the cell. In that case, you have to go over to the US tab and manually make the change yourself. An example is August 8th PM cycle, where he earned a reduction, but it just shows as #VALUE on the US tab. You don't need to go back and change all of them now, but doing that going forward, especially with numbers that influence dosing will help us help you faster.

I have a couple suggestions, based on looking at the spreadsheet, of things you can do moving forward, even before the 1 year annifursary. First of all, I see there are a number of nights where you aren't able to get a second test after PMPS. Is this something you can do going forward? Without that, you cannot follow TR. It is those second tests each cycle that answer the question "how low is this dose taking my cat?" With the answer to that question, you can follow TR and be more aggressive about increases. Which is what you need to be if you want to get him regulated. Letting him linger too long in higher numbers hurts the pancreas healing process. If you aren't seeing anything below 200, increase after six cycles (if you get those PM tests too). If you are seeing nadirs in the 100's, and they are still high 100's, you can also increase after six cycles. If they are mid 100's you can stretch it out a couple cycle, and maybe 10 cycles for very low 100's. You held the 0.75 units dose for 16 cycles, but missed second tests for 6 of those cycles. I still wouldn't have waited that long to increase.

Another suggestion deals how you dose if he's not eating well. Insulin does more than just helping balance the carbs in his food. Typically cats that are getting anaesthesia can get a half dose, when they are not allowed to eat. So instead of skipping if he's not eating, consider a half dose, or trying to assist feed if he will let you. Especially when he's in high numbers.

So if I understood correct those are the rules I need to follow from when he reach the year :

Below 2.2 (40) earn a reduction

Between 2.2-5.6 (40-100) hold the dose for 10 cycles

Around 5.6 (100) increase after 6 cycles

Nothing below 11.1 (200) increase after 6 cycles


I may need to start posting again here for guidance to adapt to the change shall I always write in the title of the fead that he is a long term diabetic for you all to understand how to guide me with dosage or no need ?
For example now I should increase on the 27 September morning if I don’t see anything below 100 (5.6)
Am I correct? I know I didn’t took the nadir one night so that’s why I am asking

 

[stefania - Noah]

also another suggestion @Wendy&Neko
When he wake me up at night and he really crave for food but I see his numbers are normal - high around 200 … shall I give him food or I stick not to ?

he eat 35 gr of late morning and evening
and I put 35 gr pate at +4 and +8
But I live with another cat so I never know who is eating from the time machine at +4 and +8 but I have the strong intuition it’s him as the other cat doesn’t have the same cravings and he is the one in front of the machine waiting for the machine to open most of the time !

so any extra food that he ask for what I do?? I just let him cry? Or …
Tonight for example I gave him extra maybe 20 gr of pate as he was going crazy all around the house !!

 

[stefania - Noah]

Also what I notice with Noah is that his nadir sometimes is not at +8 but at pre short time .. or just after the shoot .. and that confused me as sometimes I take the nadir and he is already bouncing up from a very low number that I may didn’t catch … practicality I never know when to take his nadir and if his +8 number is a number that is giving us an indication on how low he goes …

 

[stefania - Noah]

Whether a cat is newly diagnosed, or a long term diabetic, a caregiver can find that their cat doesn't hold reductions well. Meaning that they are constantly reducing, failing the reduction, then going back up in dose again. Down and up over and over. People who have a cat that doesn't hold reductions well can chose an alternate way for their cat to earn a reduction, which is for the cat to go between 40 and 49 on three separate days. Note, going under 40 would automatically earn a reduction.

We still see some cats over a year diabetic go into remission, but it's harder. The first goal is to get them regulated. It's a prerequisite of remission. So focus on regulation first.

Unfortunately, it doesn't seem to take long for their little bodies to feel comfortable in higher numbers again. With vacation, then catching up in dose, it's been a while since he saw normal BG numbers. I'm glad you are increasing now though, that will help him see more of those good numbers and get used to them again.

Yes I know that when I go abroad I go back in his journey to heal , but my pet sitter work during the day so she cannot take nadir , so I wonder sometimes if it’s correct to reduce the dose in those days or I should still risk it to keep the dose as it is even if she cannot take nadir …

 

[stefania - Noah]

Also if there are days that I work and cannot take a +8 but just a +2 … I can still follow the new rules and let’s say increase if I don’t see nothing below 200?
Or those days where I cannot take a +8 they don’t count on the 6 cycles ?
Sorry @Wendy&Neko if I’m askying so many questions
I just want to make sure I take the right approach now

as I feel so frustrated to increase and decrease all the time !!!! It’s been a very frustrated journey for me and for him as his behivior honestly it’s not regulated at all!!! Very demanding and needy … I feel so sorry to see him like this most of the time

 

[Wendy&Neko]

Around 5.6 (100) increase after 6 cycles

Between 100 and 200, increase after 6-10 cycles. I found that for Neko, I held longer the closer to 100.

shall I always write in the title of the fead that he is a long term diabetic for you all to understand how to guide me with dosage or no need ?

As long as you have the diagnosis date in the signature, which you do, we can figure it out.

When he wake me up at night and he really crave for food but I see his numbers are normal - high around 200 … shall I give him food or I stick not to ?

Do you have an idea how many calories he should get per day? If he needs to lose weight, I wouldn't feed extra, maybe just a couple all meat treats. I fed at preset meal times, and didn't change what I fed unless Neko was going low. Are you feeding multiple small meals now?

Also what I notice with Noah is that his nadir sometimes is not at +8 but at pre short time .. or just after the shoot .. and that confused me as sometimes I take the nadir and he is already bouncing up from a very low number that I may didn’t catch … practicality I never know when to take his nadir and if his +8 number is a number that is giving us an indication on how low he goes …

Neko's nadir, when she was on Lantus was reliably between +3.5 and +13, though most of the time between +7 or +9. If she was breaking a bounce, the nadir was later. If she was diving towards low numbers, it tended to be earlier. Over time I learned to spot patterns of numbers, where those patterns lasted over a few cycles. That helped me predict better when her nadir might be. I spend a LOT of time reviewing her spreadsheet data. But it really helped me figure out the best times to test.

Also if there are days that I work and cannot take a +8 but just a +2 … I can still follow the new rules and let’s say increase if I don’t see nothing below 200?
Or those days where I cannot take a +8 they don’t count on the 6 cycles ?

Yes, posting here more will help. If you can get a +2, it can often be an indicator of what the rest of the cycle will look like. Though for some cats, a +2.5 or +3 is better. If all you can get is a +2 for six cycles, I wouldn't increase based on those numbers, but rather post for here for help.

Go back to sleep, more questions tomorrow!

 

[stefania - Noah]

Between 100 and 200, increase after 6-10 cycles. I found that for Neko, I held longer the closer to 100.

As long as you have the diagnosis date in the signature, which you do, we can figure it out.

Do you have an idea how many calories he should get per day? If he needs to lose weight, I wouldn't feed extra, maybe just a couple all meat treats. I fed at preset meal times, and didn't change what I fed unless Neko was going low. Are you feeding multiple small meals now?

Neko's nadir, when she was on Lantus was reliably between +3.5 and +13, though most of the time between +7 or +9. If she was breaking a bounce, the nadir was later. If she was diving towards low numbers, it tended to be earlier. Over time I learned to spot patterns of numbers, where those patterns lasted over a few cycles. That helped me predict better when her nadir might be. I spend a LOT of time reviewing her spreadsheet data. But it really helped me figure out the best times to test.

Yes, posting here more will help. If you can get a +2, it can often be an indicator of what the rest of the cycle will look like. Though for some cats, a +2.5 or +3 is better. If all you can get is a +2 for six cycles, I wouldn't increase based on those numbers, but rather post for here for help.

Go back to sleep, more questions tomorrow!

Thanks so much for your replyes!!
Yes I’m feeding him small portion (35 gr) practically 4 times a day . Alternate 3 different low carb pate food.
I give him small portion as I see him craving anyway during the day so for me not to get stress and have the chance to calm him down I divide in small portions … correct me if I’m wrong here .. his weight is not stable .. as before diagnosis he lost lots and lots …

 

[stefania - Noah]

So I’m gonna do another post tomorrow night to double check with you about the eventual increase we should give him the day after tomorrow
(After 6cycles)

thanks for now
I’m going back to sleep

 

[stefania - Noah]

I also notice that the more I increase his dose the more I see pink numbers .. like now I increase at 1 unit and it’s the second day his preshoot number is very high