Diet change working wonders! Now concerned about high insulin dose

FluffyP

FluffyP

Member
Link to previous thread: https://www.felinediabetes.com/FDMB...ing-neuropathy-considering-euthanasia.289997/

First off I just to say thank you to this wonderful community. While me and Fluffy still have a long way to go for real regulation, I'm seeing signs of a remarkable turn around. The information I've been provided here may very well be responsible for saving my best friends life.

Fluffy has taken remarkably well to the diet change from a high carb dry food to a low carb wet food (fancy feast classic chicken feast). We are almost done with the transition and over the next few days he should be on a 100% wet food diet.

I'm seeing a drastic reduction in his overall blood glucose levels. I'm going to be testing vigorously over the next few days since I'll be off work. But the drastic reduction of numbers has me concerned about his high dose. He's currently on 6 units of prozinc as instructed by his previous vet ( who I've moved on from). I am concerned that since it's such a high dose I may be putting him at hypo risk over the next few cycles if the numbers continue in the same trajectory. I'll be testing overnight to have a decent idea of his cycle numbers, but am looking for feedback on what I should do for his next cycle and subsequent cycles afterwards.

I never expected the diet change to have this much of an impact so wondering if I should mess with dosage and go a bit lower to be safe while I find a happy medium?
 
Hi there! I’m really happy that you have almost completed the transition to LC wet food. You certainly saw some much better numbers last night! How wonderful to see a blue on that spreadsheet after seeing the nasty reds and blacks. Oh, before I forget, your spreadsheet date for today says it’s the 16th of May and needs to be changed to the 18th.

If you can get as many tests as you can over the next few days, we will have a much better idea of whether or not it’s a good idea to lower his dose. We need to find his nadir. Did he have all low carb food last night?
 
Suzanne & Darcy said:
Hi there! I’m really happy that you have almost completed the transition to LC wet food. You certainly saw some much better numbers last night! How wonderful to see a blue on that spreadsheet after seeing the nasty reds and blacks. Oh, before I forget, your spreadsheet date for today says it’s the 16th of May and needs to be changed to the 18th.

If you can get as many tests as you can over the next few days, we will have a much better idea of whether or not it’s a good idea to lower his dose. We need to find his nadir. Did he have all low carb food last night?
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Ah good catch with the date, totally missed it.

And mostly low carb, his meal split last night was at least 80 % low carb wet food and 20% Purina dm dry food, if not a little higher wet food percentage. I just took that +5 blue reading about 20 minutes ago so he has about another 6 and half hours before his next meal and subsequent dose.

I'll try and get a reading each of the next two or three hours. He might be a little upset at me for waking him up multiple times though :arghh: :D
 
And will he be doing all low carb today? And you will be testing? And you have karo syrup and HC food ready if needed? With the Alpha Trak, your take action number is 68 - so no HC food unless Fluffy drops below 68.
 
That was a very high blue last night (almost yellow) so I think you have some wiggle room even with the low carb transition - especially since that was at +5 and must have been close to nadir. He would have to drop a long way before getting close to 68. The best way to approach this is to just test your sweet boy a lot so we can see the full effect of the LC switch.
 
Suzanne & Darcy said:
And will he be doing all low carb today? And you will be testing? And you have karo syrup and HC food ready if needed? With the Alpha Trak, your take action number is 68 - so no HC food unless Fluffy drops below 68.
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My intention was to keep the split similar 80/20, maybe bump it up a little if anything. I'll be testing as much as possible but may need to get a couple hours off shut eye here and there.

Unfortunately I'm embarrassed to admit I'm a little unprepared for a hypo event. I've been at high 500+ levels for so long that I never thought I'd be anywhere near such a scenario. That's partially why I'm trying to be as cautious as possible.

Edit: My local stores won't open for a few hours but I'll make a trip to pick up karo syrup and some HC wet food when they do
 
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So you are not planning to cut out the HC food? That’s going to make things rather wonky and complicated. The HC will raise BG for a longer period of time (especially if it’s dry food) and could influence numbers even into the next cycle. It’s going to be hard to interpret spreadsheet data with HC food involved. At least you will need to chart on the SS what food was given and when (at which +hour.) You do know already to not give food for two hours prior to the preshot tests? And to not feed after nadir? I see you have a long thread over on the Feline Health forum, but I haven’t had time to read through all of it.
 
Agree with Suzanne, test, test, test as much as you can while you can. I'm really hoping he doesn't bounce for the next 3 days from that lovely blue :cool: - we should be able to tell though, from the numbers you gather.

Are you CST time zone? What time do you shoot? I'm coming up with 1am/pm your time - I probably won't be around for your shot times, but, I have a chance to be around a bit more this coming week & am anxious to see how Fluffy does! :)
 
Shelley & Jess said:
Agree with Suzanne, test, test, test as much as you can while you can. I'm really hoping he doesn't bounce for the next 3 days from that lovely blue :cool: - we should be able to tell though, from the numbers you gather.

Are you CST time zone? What time do you shoot? I'm coming up with 1am/pm your time - I probably won't be around for your shot times, but, I have a chance to be around a bit more this coming week & am anxious to see how Fluffy does! :)
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That is correct I shoot at 1:30 pm and 1:30 am.

I'm off work for 3 days starting today so I should be able to get some pretty consistent testing numbers
 
Suzanne & Darcy said:
So you are not planning to cut out the HC food? That’s going to make things rather wonky and complicated. The HC will raise BG for a longer period of time (especially if it’s dry food) and could influence numbers even into the next cycle. It’s going to be hard to interpret spreadsheet data with HC food involved. At least you will need to chart on the SS what food was given and when (at which +hour.) You do know already to not give food for two hours prior to the preshot tests? And to not feed after nadir? I see you have a long thread over on the Feline Health forum, but I haven’t had time to read through all of it.
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Oh yes I'm very much planning to cut the HC food out completely. Fluffy was just a dry food cat his entire life up until 4 days ago. So my goal was to transition using a mix over the course of a week so as not to upset his tummy.

To clarify though, I am strict when adhering to test/feed/shoot so other than a small freeze dried treat during testing he has no food influencing testing during other points of the day.
 
Ok so just did his AMPS reading and it was back up to 483. A little bit of a bummer but I'm still optimistic we are trending in the right direction. Also allays my fears about the high dosage for the time being so he's getting his usual 6 units. I'm also confident his tummy is taking the wet food well so starting this morning he's on a pure LC wet food diet.

Also I purchased some karo syrup and HC wet food in case of an emergency. I'll be updating spreadsheet throughout the day today as well. Going to do everything in my power to gather as much data as possible.
 
FluffyP said:
Oh yes I'm very much planning to cut the HC food out completely. Fluffy was just a dry food cat his entire life up until 4 days ago. So my goal was to transition using a mix over the course of a week so as not to upset his tummy.

To clarify though, I am strict when adhering to test/feed/shoot so other than a small freeze dried treat during testing he has no food influencing testing during other points of the day.
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The feeding schedule should be something like this: meal at AMPS and PMPS.
Snack at +2
Snack at +4
Can also give a snack at +6 but not after cat’s typical nadir time.
Snacks can be 1-2 teaspoons of wet low carb food.
This would be for regular days. On days where you are steering low numbers you would obviously deviate from this based on the numbers (e.g. you may need to feed medium carb or high carb and you may be giving small amounts of food as often as every 20-30 minutes.). But this would be a basic daily feeding schedule. The snacks are important to smooth the cycle and prevent steep drops in order to help prevent bouncing.
 
I forgot to add that you can buy a timed feeder to dispense the snacks at the appropriate time of day while you’re working. This will be especially important to keep Fluffy safe while you’re away from home.
 
Uh oh, it looks like he is perhaps bouncing from the blue last night. His body isn’t used to being in numbers that low. Hopefully he won’t take too many cycles to clear the bounce! They can (but don’t necessarily) take up to six cycles to clear. Keep up the food transition (and yes, you are right to do it slowly to help prevent GI upset which cats are so prone to with dietary changes. Just be sure to write down in your notes section of the spreadsheet about where you are with the food transition and to note when he’s on 100 percent low carb food.
 
Suzanne & Darcy said:
The feeding schedule should be something like this: meal at AMPS and PMPS.
Snack at +2
Snack at +4
Can also give a snack at +6 but not after cat’s typical nadir time.
Snacks can be 1-2 teaspoons of wet low carb food.
This would be for regular days. On days where you are steering low numbers you would obviously deviate from this based on the numbers (e.g. you may need to feed medium carb or high carb and you may be giving small amounts of food as often as every 20-30 minutes.). But this would be a basic daily feeding schedule. The snacks are important to smooth the cycle and prevent steep drops in order to help prevent bouncing.
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Ok this is really good to know. Probably would've been good to give one last nights when his numbers were going down at a high rate I'm assuming? I'll begin incorporating that soon for sure. Thank you.
 
FluffyP said:
Ok this is really good to know. Probably would've been good to give one last nights when his numbers were going down at a high rate I'm assuming? I'll begin incorporating that soon for sure. Thank you.
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Exactly. I was looking at your spreadsheet this morning and kind of wondering about that drop. It really is good for cats on insulin to have a feeding schedule like this. It can be tweaked over time, of course, as we see Fluffy’s patterns. I am really optimistic about Fluffy’s progress.
 
Okay. I am excited to see how well Fluffy is doing. He got right back to work with the insulin. I’m loving the blues. So far everything is quite safe numbers wise. :cool:
 
Oh wow, more blues! While those blues were very safe, my only concern, I'd be considering a dose reduction if you find you need to keep feeding HC to keep his numbers flat - it's a good strategy while you're home and can monitor, but, that's not always going to be the case. While you're available, I'd take the time to find a good dose that doesn't need HC intervention.

To me feeding HC at +4 that kept him flat to +5 suggests he would have more than likely kept heading down and hit green.
 
Shelley & Jess said:
Oh wow, more blues! While those blues were very safe, my only concern, I'd be considering a dose reduction if you find you need to keep feeding HC to keep his numbers flat - it's a good strategy while you're home and can monitor, but, that's not always going to be the case. While you're available, I'd take the time to find a good dose that doesn't need HC intervention.

To me feeding HC at +4 that kept him flat to +5 suggests he would have more than likely kept heading down and hit green.
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I agree with Shelley. Of course, green is good, but we don’t know how low he would have gone without the HC. It muddies the waters. As a general rule, we don’t give HC unless the cat drops below 50. The snacks should all be low carb and that should be enough to keep things in check. If not, then we know that a dose reduction is warranted. Of course, we will never let them just drop into unsafe numbers. You can even experiment with feeding a little higher end LC (like 8 or 9 percent carbs). Anything under 10 percent is still considered LC. If you’re having a really steep drop, some people find that they need to give a little medium carb. But you would be surprised how a little LC will smooth the cycle for most cats (unless, as I said, Fluffy needs a dose reduction.)
 
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Sorry guys, I ended up kinda panicking a bit about seeing such a steep drop that I reached for the HC wet food to try and limit it so that the bounce wouldn't be as extreme. The 556 PMS reading just set alarms bells off for me.

But yes I'd love to hear your thoughts on a dose reduction. I'm off work the next 4 cycles but on 5/22/24 I'll be back at work and not being able to keep a close eye makes me a little nervous.

Any starting points y'all would recommend to try and test out ?
 
Oh! Don't ever be sorry for wanting to keep Fluffy safe!

Cats tend to bounce harder when the drop is more than 50% from preshot to nadir. You were at about a 75% drop at +4 and still had a couple hours to go until expected nadir - with so little data, you did the right thing!!

Feeding only LC now I'm thinking a 0.5 unit reduction to start - that 6 units cut through some pretty high numbers. Let's see what @Suzanne & Darcy thinks.
 
I would agree with cutting the dose to 5.5 units. I hope you have the syringes with the half unit markings. If you start right away with the next shot and feed low carb then we will be able to see how Fluffy does for the next 4 cycles while you are at home then we will have a good idea of how the new dose is working.
 
Looks like he bounced really really hard again. 671 the highest number I've gotten since I started testing. We also had apartment maintenance show up unexpectedly this morning to do work inside and there was lots of lots noise that definitely stressed him out so possible that contributed as well.


Trying the 5.5 units so I'll let y'all know how it goes.
 
Looks like we had a pretty good couple of cycles with the 5.5 units. I was a little nervous with the PMPS number being as low as it was and still giving 5.5 units given the drops we had seen earlier but it seems like he handled it well.

Is there a pre shot number that you would consider too low for the 5.5? If he is the 100s do you think I should do a half dose? Skip?

@Suzanne & Darcy
@Shelley & Jess
 
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FluffyP said:
Is there a pre shot number that you would consider too low for the 5.5? If he is the 100s do you think I should do a half dose? Skip?
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I'd really like to see how the current cycle behaves and maybe even the next. He's still settling in, it varies, but, it can take some cats quite a few cycles after removing all dry to see what the full effects will be. We've had 4 full cycles of no dry and 2 since the HC wet - we can't be sure just yet if there's any lingering effect left.

I'm watching for your AM+2.
 
Shelley & Jess said:
I'd really like to see how the current cycle behaves and maybe even the next. He's still settling in, it varies, but, it can take some cats quite a few cycles after removing all dry to see what the full effects will be. We've had 4 full cycles of no dry and 2 since the HC wet - we can't be sure just yet if there's any lingering effect left.

I'm watching for your AM+2.
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Just updated results for am +3 and +4. I think we're still a couple hours away from nadir based on what I've seen? Kinda expecting to go into Green but we'll see.

Didn't test at +2 but I did give him his snack, and just now gave him snack at +4. Just for clarification the HC wet food I gave him a couple nights ago was a really small portion of the fancy feast grilled in gravy chicken. Maybe a teaspoon total.

I'm keeping a close eye next two hours to make sure he doesn't go too low.
 
As a reminder, 68 is the take action number for a pet meter. (50 if using a human meter).

And, good info about the HC fed, when we look back we can see how that small amount stopped the drop. :)
 
Shelley & Jess said:
As a reminder, 68 is the take action number for a pet meter. (50 if using a human meter).

And, good info about the HC fed, when we look back we can see how that small amount stopped the drop. :)
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I’m looking at the notes for today and don’t see anything about HC. This is what I see for today’s notes
 

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Ok so looks like he hit nadir and is gonna make his way back up. +5 was 85 and +6 was 89. I also took a reading at the halfway point of those two (+5.5) and it was 84. I also gave him tiny little portions of pure bites freeze died chicken treats to help him through the testing process ( which I almost always do). Not sure if there's any kind of meaningful carbs with those but something to consider as well I suppose?

Those are really really promising numbers. Never thought I'd hit green so soon after switching foods. But it does concern me that we went all the way from 230 to just 20 points above the take action point. I'm thinking maybe a lower dose tonight if his pmps shows anything under 230? What are y'all's thoughts. I'm doing my best to stay up with him overnight but I've been really been pushing myself last 2 weeks or so and especially the last couple days.
 
Okay so… so far you have gathered enough data to sho us that the lower 200s are safe to shoot the 5.5 units (this is assuming that Fluffy doesn’t drop below 68 today.). Hopefully we can still get a little more data before you go back to work. Or is that tomorrow? You go back to work tomorrow? Well, we will have to be cautious until we can gather even more data. The goal is to be able to shoot lower preshots eventually, but you can work your way down when you are at home and can monitor the cycles. Tell me about how many hours you will be gone during your workday and when you will be home (what + hour.) ?
 
FluffyP said:
Ok so looks like he hit nadir and is gonna make his way back up. +5 was 85 and +6 was 89. I also took a reading at the halfway point of those two (+5.5) and it was 84. I also gave him tiny little portions of pure bites freeze died chicken treats to help him through the testing process ( which I almost always do). Not sure if there's any kind of meaningful carbs with those but something to consider as well I suppose?

Those are really really promising numbers. Never thought I'd hit green so soon after switching foods. But it does concern me that we went all the way from 230 to just 20 points above the take action point. I'm thinking maybe a lower dose tonight if his pmps shows anything under 230? What are y'all's thoughts. I'm doing my best to stay up with him overnight but I've been really been pushing myself last 2 weeks or so and especially the last couple days.
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It’s great to see how he stabilized in healthy greens with only low carb. Don’t worry about the Pure Bites testing treats. It not a source of carbs to elevate BG.
 
Suzanne & Darcy said:
Okay so… so far you have gathered enough data to sho us that the lower 200s are safe to shoot the 5.5 units (this is assuming that Fluffy doesn’t drop below 68 today.). Hopefully we can still get a little more data before you go back to work. Or is that tomorrow? You go back to work tomorrow? Well, we will have to be cautious until we can gather even more data. The goal is to be able to shoot lower preshots eventually, but you can work your way down when you are at home and can monitor the cycles. Tell me about how many hours you will be gone during your workday and when you will be home (what + hour.) ?
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I ended up taking the day off tomorrow so I'll be able to do another round of good data gathering, however, I will be going back to work the following day. I work 10 hour days so I usually have to leave the house at AM +1 and am not back home until it's time for PMPS. In my opinion that means I have to be EXTRA cautious with my preshoots. I live alone too, so he is unfortunately unmonitored during those times. I have family members than can occasionally check on him but not anywhere near enough to a consistent part of the equation.
 
FluffyP said:
Ok so looks like he hit nadir and is gonna make his way back up. +5 was 85 and +6 was 89. I also took a reading at the halfway point of those two (+5.5) and it was 84. I also gave him tiny little portions of pure bites freeze died chicken treats to help him through the testing process ( which I almost always do). Not sure if there's any kind of meaningful carbs with those but something to consider as well I suppose?

Those are really really promising numbers. Never thought I'd hit green so soon after switching foods. But it does concern me that we went all the way from 230 to just 20 points above the take action point. I'm thinking maybe a lower dose tonight if his pmps shows anything under 230? What are y'all's thoughts. I'm doing my best to stay up with him overnight but I've been really been pushing myself last 2 weeks or so and especially the last couple days.
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If you do have a preshot for PMPS of below 230 — or even around 230, I might try cutting another half unit off the dose (to 5 units.). The thing is, I don’t think we have to rush this process. You can always increase if necessary if a dose just isn’t getting Fluffy into desirable numbers. I am wondering at what hour in the cycle you will return home. And you have an automatic feeder to dispense the snacks?
 
Suzanne & Darcy said:
If you do have a preshot for PMPS of below 230 — or even around 230, I might try cutting another half unit off the dose (to 5 units.). The thing is, I don’t think we have to rush this process. You can always increase if necessary if a dose just isn’t getting Fluffy into desirable numbers. I am wondering at what hour in the cycle you will return home. And you have an automatic feeder to dispense the snacks?
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Yep, he earned a reduction going below 90. Thinking the same, I'd reduce another 0.5 units - new dose 5.0 units if he's high enough to shoot.
 
FluffyP said:
I ended up taking the day off tomorrow so I'll be able to do another round of good data gathering, however, I will be going back to work the following day. I work 10 hour days so I usually have to leave the house at AM +1 and am not back home until it's time for PMPS. In my opinion that means I have to be EXTRA cautious with my preshoots. I live alone too, so he is unfortunately unmonitored during those times. I have family members than can occasionally check on him but not anywhere near enough to a consistent part of the equation.
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I am happy about the extra day. But I agree about being extra cautious until we can gather even more data on your off days so that you can be confident in your dosing. If that means Fluffy runs a little higher for the next couple of weeks then so be it. It will still be okay and better than the reds and blacks. We can do this incrementally.
 
Suzanne & Darcy said:
If you do have a preshot for PMPS of below 230 — or even around 230, I might try cutting another half unit off the dose (to 5 units.). The thing is, I don’t think we have to rush this process. You can always increase if necessary if a dose just isn’t getting Fluffy into desirable numbers. I am wondering at what hour in the cycle you will return home. And you have an automatic feeder to dispense the snacks?
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When I get home it's already PMPS time. Maybe with anywhere from 15-30 minutes to spare. It's not ideal


Ok that's what I was thinking as well. Id very much like to err on the side of caution. I think I will go to 5.0 units if we're in the area of 230. I'm also not in a rush to be in a completely ideal situation. I'm completely ok going to 4.5 as well if it means being that's much safer as well. Given I spent 4 months being told to raise and raise the dose, the idea of reducing feels like a victory in and of itself.

My automatic feeder should be in either tonight or tomorrow so I should almost guarantee I will have it set up by the time I return to work.
 
FluffyP said:
When I get home it's already PMPS time. Maybe with anywhere from 15-30 minutes to spare. It's not ideal


Ok that's what I was thinking as well. Id very much like to err on the side of caution. I think I will go to 5.0 units if we're in the area of 230. I'm also not in a rush to be in a completely ideal situation. Given I spent 4 months being told by a vet to raise and raise the dose, the idea of reducing feels a victory in and of itself.

My automatic feeder should be in either tonight or tomorrow so I should almost guarantee I will have it set up by the time I return to work.
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It IS a victory! We should celebrate this progress. I was really happy to see a yellow preshot this a.m. cycle! We have time and we need to get this right!
 
In the event that he's sub 200 at PMPS in couple of hours would you all advise that I still shoot? Maybe a heavily modified dose? Somewhere around 4 - 4.5 maybe or less?

Figured I'd check in advance since it's usually pretty late for most NA members here by then.
 
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If he’s under 200 at PMPS then yes I think you could try 4 units as long as you can monitor the cycle. Now if he had a preshot that was really unexpected like below 150, I would consider shooting something much lower like maybe 2 units. It may not be nearly enough insulin, but it’s all a matter of gathering data to see how he responds. I hope he won’t be that low actually.
 
Suzanne & Darcy said:
If he’s under 200 at PMPS then yes I think you could try 4 units as long as you can monitor the cycle. Now if he had a preshot that was really unexpected like below 150, I would consider shooting something much lower like maybe 2 units. It may not be nearly enough insulin, but it’s all a matter of gathering data to see how he responds. I hope he won’t be that low actually.
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Got it!

And just wanted to say thank you and to @Shelley & Jess as well. You've done so much to help me and guide me and fluffy. Not sure how I'd be doing this without y'all's advice and guidance. From the bottom of my heart, genuinely, thank you. :bighug:
 
@FluffyP
Hi if you are following SLGS method
When following SLGS with the Alpha Trak you reduce if the BG falls under 90. Which I see Fluffy did today .
I will tag Suzanne and Shelly just to confirm this
I assume you would reduce by 0.25 units so the new dose would be 5.25 units
Can you add to your signature SLGS and what you are feeding Fluffy
By the way Fluffy is adorable!
@Suzanne & Darcy
@Shelley & Jess
 
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