Emmett's numbers continued--time to reduce dose?

KLD

KLD

Active Member
Previous post here.

Emmett has been on 3.75 units for over a week now. Overall, he seems to be doing fairly well, though I still don't like how high his preshot numbers tend to get. He's also had some bouncing numbers, but seems to be levelling out fairly quickly from it.

Today he just tested at 3.5/63 at nadir. I panicked a little at that number and gave him some medium carb food, though I don't know if that was a bit premature and I should have waited to see if he went any lower.

I'm wondering if it's time to reduce his dose back to 3.5 units? His numbers don't seem all that consistent to me yet, especially overnight (though I need to get better at more consistently testing him during the PM cycle), but obviously I don't want him going too low.

Thanks!
 
Hi there! I’m happy to see some better numbers on Emmett’s spreadsheet. It was overkill to give MC with that 63 today, but most of us have overreacted and done something similar at one point in our journey. That would have been a time to give a small LC snack and test again in 30 minutes.
Is he getting a snack at +2 and is he getting another one at +4 with all snacks being finished prior to his nadir?
 
And yes, unfortunately, as you are following SLGS for now — with that 63 today you should reduce back down to 3.5 units. You can always go back up again if he’s not doing well after the reduction. Let’s hope things will smooth out over time!
 
Suzanne & Darcy said:
Hi there! I’m happy to see some better numbers on Emmett’s spreadsheet. It was overkill to give MC with that 63 today, but most of us have overreacted and done something similar at one point in our journey. That would have been a time to give a small LC snack and test again in 30 minutes.
Is he getting a snack at +2 and is he getting another one at +4 with all snacks being finished prior to his nadir?
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I figured it was overkill, but it’s the first time I’ve seen that number so like I said, I panicked lol.

And correct, he gets snacks on that schedule.
 
KLD said:
I figured it was overkill, but it’s the first time I’ve seen that number so like I said, I panicked lol.

And correct, he gets snacks on that schedule.
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I thought so — about the snacks, that is.
I hope he’s not still acting like he may have pancreatitis?
 
Suzanne & Darcy said:
And yes, unfortunately, as you are following SLGS for now — with that 63 today you should reduce back down to 3.5 units. You can always go back up again if he’s not doing well after the reduction. Let’s hope things will smooth out over time!
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Thanks! I’m sort of expecting him to bounce again after this number. I’m hoping he won’t be in the red tonight, but I also wouldn’t be surprised.
 
Suzanne & Darcy said:
I thought so — about the snacks, that is.
I hope he’s not still acting like he may have pancreatitis?
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Nope, not acting like he’s feeling unwell at all. In fact, he is clearly feeling GREAT since we started seeing numbers in the normal range. Unfortunately, his eosinophilic granuloma is back on his lip, which is what triggered this whole diabetic journey in the first place (it had been treated with steroids).
 
KLD said:
Nope, not acting like he’s feeling unwell at all. In fact, he is clearly feeling GREAT since we started seeing numbers in the normal range. Unfortunately, his eosinophilic granuloma is back on his lip, which is what triggered this whole diabetic journey in the first place (it had been treated with steroids).
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I totally understand about the Eosinophilic Granuloma. I have a cat who gets those occasionally. I did get a steroid shot for her last time, but some months later it came back and I haven’t taken her for another one. I was hoping it would go away on its own. It has kind of waxed and waned a bit since then.
 
Suzanne & Darcy said:
I totally understand about the Eosinophilic Granuloma. I have a cat who gets those occasionally. I did get a steroid shot for her last time, but some months later it came back and I haven’t taken her for another one. I was hoping it would go away on its own. It has kind of waxed and waned a bit since then.
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Yeah, he gets them a couple times a year. I’m not sure what triggers it, but it typically takes a couple weeks to clear on its own. I’m not sure if it’s worth treating at this point. The worst is when he gets them on his paws because those ones annoy him when he gets them. I’m not sure what other treatment there is besides steroids.
 
My vet always treats with a Depo Medrol injection. I suppose maybe Atopica would be another option, but it is somewhat expensive and requires more monitoring in terms of bloodwork as I recall. I have never had any luck with Zyrtec or other antihistamines (for any of my cats with skin problems.)
 
Suzanne & Darcy said:
My vet always treats with a Depo Medrol injection. I suppose maybe Atopica would be another option, but it is somewhat expensive and requires more monitoring in terms of bloodwork as I recall. I have never had any luck with Zyrtec or other antihistamines (for any of my cats with skin problems.)
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Oh that’s really good to know. He has a vet appointment on Monday just for his yearly check up/boosters, so I’m sure we’ll go over some non-steroid options.
 
KLD said:
Oh that’s really good to know. He has a vet appointment on Monday just for his yearly check up/boosters, so I’m sure we’ll go over some non-steroid options.
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Well, Atopica is also immunosuppressive; it’s just not a steroid. I haven’t researched its effect upon blood glucose yet.
 
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Hello! I was hoping I could get some advice on Emmett’s dose. Full disclosure, I’ve been sort of inconsistent with Emmett’s dose, mainly because his preshot numbers have varied so greatly.

3.75 units was making Emmett go too low, so I reduced him back to 3.5 units, which from what I can tell he’s been responding to better. However, tonight his pre shot number was extremely high at 30.4 (on the alpha trak 3).

Side note: I’ve switched back to the Alpha Trak 3 (as of tonight) because his insurance covers the strips and it ends up being cheaper for me.

I officially don’t know what’s going on with his numbers, particularly the preshot numbers. I know he’s had some bouncing from the lower numbers, and perhaps the numbers have been going lower than I’m catching. Any insight into why his number might be so high tonight? It’s made me question the accuracy and reliability of the Freestyle Lite I was using for the past month, since I haven’t seen black numbers in over a month when I was previously using the AT3, but that could just be coincidence.

Thanks!
 
Good morning. It’s good to hear from you! I hope you and Emmett are doing well. I am going over his spreadsheet, but first I want to ask you if he is getting small amounts of food at +2 and +4 (every day, not just when his numbers end up being low.). He should be having some food always at least at those points in the cycle — and it’s possible he may need a few more carbs if he has been getting low carb food at those times. I don’t mean medium carb but maybe something around 7/8 percent.
 
Suzanne & Darcy said:
Good morning. It’s good to hear from you! I hope you and Emmett are doing well. I am going over his spreadsheet, but first I want to ask you if he is getting small amounts of food at +2 and +4 (every day, not just when his numbers end up being low.). He should be having some food always at least at those points in the cycle — and it’s possible he may need a few more carbs if he has been getting low carb food at those times. I don’t mean medium carb but maybe something around 7/8 percent.
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Good morning! We are doing well! A little stressed (me) because we’re moving in a couple days, and a little bit in pain (Emmett) because his eosinophilic granuloma on his lip is not fully healed, and he’s got another (suspected) popping up on his paw that is really bothering him. I’m going to have to do an elimination diet to figure out what he’s allergic to.

Yes, he gets snacks at +2, +4, and usually +6 since that seems to be his nadir usually. Fancy feast pates. I just don’t generally put that in his spreadsheet since it’s always the same, but maybe I should so it’s clear to others.

I think I have some food that is slightly higher in carbs, but still low carb. I know his purina DM is about 10% and I have some merrick pate my non diabetic cat eats, which I believe is around 6% if I’m remembering the chart correctly.
 
KLD said:
Good morning! We are doing well! A little stressed (me) because we’re moving in a couple days, and a little bit in pain (Emmett) because his eosinophilic granuloma on his lip is not fully healed, and he’s got another (suspected) popping up on his paw that is really bothering him. I’m going to have to do an elimination diet to figure out what he’s allergic to.

Yes, he gets snacks at +2, +4, and usually +6 since that seems to be his nadir usually. Fancy feast pates. I just don’t generally put that in his spreadsheet since it’s always the same, but maybe I should so it’s clear to others.

I think I have some food that is slightly higher in carbs, but still low carb. I know his purina DM is about 10% and I have some merrick pate my non diabetic cat eats, which I believe is around 6% if I’m remembering the chart correctly.
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It sounds like you are doing it all correctly! I was pretty sure we had already talked about it, but he’s really taken a few early dives recently. I was wondering of maybe he was not eating well on those days.
 
Suzanne & Darcy said:
It sounds like you are doing it all correctly! I was pretty sure we had already talked about it, but he’s really taken a few early dives recently. I was wondering of maybe he was not eating well on those days.
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He always eats well, to be honest. He still constantly acts like he’s starved, but the 1.5 pound weight gain since starting insulin tells a different story lol
 
Suzanne & Darcy said:
I remember you said the ones on his paw really bothered him.
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He acts distressed until I come lift him off whatever higher surface he’s on. Breaks my heart because I wish I could figure out what’s causing it. It’s clearly something he’s eating more frequently since diagnosis and diet changes because he’s never had this many pop up so close together in time.
 
KLD said:
He acts distressed until I come lift him off whatever higher surface he’s on. Breaks my heart because I wish I could figure out what’s causing it. It’s clearly something he’s eating more frequently since diagnosis and diet changes because he’s never had this many pop up so close together in time.
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Oh that sounds painful. It could be the Fancy Feast? Some ingredients? You could experiment with different proteins and try a single source protein or a novel protein (something he’s never eaten before.). That is easier said than done, of course. I do know that chicken is one of the top proteins that cats are allergic to. Remind me what he was eating before?
 
Suzanne & Darcy said:
Oh that sounds painful. It could be the Fancy Feast? Some ingredients? You could experiment with different proteins and try a single source protein or a novel protein (something he’s never eaten before.). That is easier said than done, of course. I do know that chicken is one of the top proteins that cats are allergic to. Remind me what he was eating before?
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My top suspect is chicken. Before diabetes, he was eating Hills metabolic dry food (which I believe is chicken). Before that, he was eating Farmina boar and apple (which also has chicken). He’s also had Merrick chicken dry food. He’s gotten lesions with all these foods. That being said, far less frequently than he’s getting them now. There’s been a few other dry foods he’s gotten (he gets tired of dry food flavours quickly) but I’m blanking on them now. Since switching him to Fancy Feast and feeding chicken flavours more frequently, it seems to be an issue now.

For a couple months before diagnosis, he was eating mainly beef and rabbit flavoured wet foods (chunks in gravy, which is why I switched him off those). He seems to do fine with those proteins.
 
He is doing mostly great on the 3.5 units. I like it. Who knows where that black PMPS came from last night… unless it was a bad strip. But didn’t you also check it with a different meter? Good luck with your move. Are you going far? His numbers may go up a bit if he gets stressed. I would guess that the Eosinophilic Granulomas could elevate his numbers as well, but he appears to be doing great.
 
Suzanne & Darcy said:
He is doing mostly great on the 3.5 units. I like it. Who knows where that black PMPS came from last night… unless it was a bad strip. But didn’t you also check it with a different meter? Good luck with your move. Are you going far? His numbers may go up a bit if he gets stressed. I would guess that the Eosinophilic Granulomas could elevate his numbers as well, but he appears to be doing great.
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Yes, I’m really happy with where he seems to be stabilizing after that bounce (maybe his body didn’t like the jump from his pre shot number to his nadir? Who knows). It definitely wasn’t a bad strip because I did check it against a different meter, and he continued to test high throughout the night.

Thank you! I’m not going far, which is good because now I’ll have to drop off the cats at my parents’ house on the days I’m in the office for work. Emmett is pretty chill so I’m hoping he adjusts well. I’m just moving out of my parents’ so the cats don’t have to be moved over until everything is settled.

Emmett had a really low pre shot number this morning. I ended up skipping his dose because obviously it wouldn’t have been safe, and I’m in the office today so unable to check on him. What should I have done if I were around to monitor? Still skip? Delay? Token dose and monitor?
 
Okay. If you were going to be able to test him at all then I would have tried a reduced dose of maybe 1 unit, which is probably way too low, but we have no history that I can see with him having this low of a preshot. So I would prefer to start very conservatively with the lower preshots. As we gather data, we will have a much better idea of how he will do with those lower preshot numbers. If you have the time, then you can also stall 30 minutes to an hour and don’t give him any food during that time. Then retest I can see if his BG is rising and by how much.

I can see from his spreadsheet that he is making progress so you probably will have to gradually get used to shooting lower numbers.
 
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Suzanne & Darcy said:
Okay. If you were going to be able to test him at all then I would have tried a reduced dose of maybe 1 unit, which is probably way too low, but we have no history that I can see with him having this low of a preshot. So I would prefer to start very conservatively with the lower preshots. As we gather data, we will have a much better idea of how he will do with those lower preshot numbers. If you have the time, then you can also stall 30 minutes to an hour and don’t give him any food during that time. Then retest I can see if his BG is rising and by how much.

I can see from his spreadsheet that he is making progress so you probably will have to gradually get used to shooting lower numbers.
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Thank you! Yes, I had debated giving him 1 unit, but thought I probably should hold off if I wasn’t going to be able to monitor him. Unfortunately I have a two hour commute to work, so mornings I’m in the office are very rushed and I don’t have time to stall. Hopefully this day without insulin won’t put him off track too much.

I have no problem shooting the lower numbers in theory… as long as I’m home that day lol. His vet doesn’t want his preshot numbers to go below 15 because of the risk of going too low, but I don’t see how that is sustainable if the goal is to get him into remission.
 
KLD said:
Thank you! Yes, I had debated giving him 1 unit, but thought I probably should hold off if I wasn’t going to be able to monitor him. Unfortunately I have a two hour commute to work, so mornings I’m in the office are very rushed and I don’t have time to stall. Hopefully this day without insulin won’t put him off track too much.

I have no problem shooting the lower numbers in theory… as long as I’m home that day lol. His vet doesn’t want his preshot numbers to go below 15 because of the risk of going too low, but I don’t see how that is sustainable if the goal is to get him into remission.
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I agree. You have to be able to het him into greens to let his pancreas have the best chance of healing.
 
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Ah, my poor boy was at 33/594 this evening. He cleared that high number a couple days ago pretty quickly so let’s hope he recovers quickly from this.
 
It’s probably just the skipped shot with no insulin he went very high— or a combination of the low this morning and then no shot on top of it. I hope he does come back down quickly.
 
Suzanne & Darcy said:
It’s probably just the skipped shot with no insulin he went very high— or a combination of the low this morning and then no shot on top of it. I hope he does come back down quickly.
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For sure. This boy clearly loves his numbers in the black. I just tested him at +3 and he’s at 17.5. I think that’s pretty good considering where he started. I’m confident he’ll get back to where he needs to be.
 
Emmett tested at “HI” this morning. Scary. I’ve never seen that before with him. Clearly he cannot go a day without insulin. Hopefully we can get those numbers down today.
 
The good news is that the insulin is definitely doing its job today. I’m pretty hopeful he’ll get back to normal. I’m definitely not skipping a dose with him again lol.
 
KLD said:
The good news is that the insulin is definitely doing its job today. I’m pretty hopeful he’ll get back to normal. I’m definitely not skipping a dose with him again lol.
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Oh! Nice blues. I like that much better! I agree about not skipping the dose, but the trick is to figure out how much to give.
 
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