Twix_Low AMPS Reading

Well... I definitely don't know where to go from here. When I got home today he was at 107. Granted, I have 2 more hours until he's due for a shot. I know SLGS mentions not to give insulin if he is below 150. But in the event he gets above 150 in the next couple of hours, I am not sure of the best course of action. It looks like he also dropped below 90 today, which would call for a 0.25 reduction, but he dropped from his token dose of 0.75. So I would assume that I would decrease the dose based on the token dose and not his original dose? Oh my! I mean this at least seems like a very good sign...
 
I have not shot yet. And I’m not too far past his time. I can do 0.25. The SLGS method mentioned nothing under 150, so I was going off that. His reading is different now (169) but he has eaten so it’s not reliable.
 
That’s fine. SLGS says you should gradually reduce your no shot number but do not shoot if under 90. If following MPM then you can shoot anything 50 and above but only if you have data to support that. We’re not there yet.
 
Most of my people end up moving to MPM to keep their cats in the best numbers, but oh my…. Twix is moving so quickly. He is doing great. We don’t have enough information on him yet, but I feel like the token dose of .25 will give him just a little insulin support. You are very fortunate that he is not a cat who bounces up high after being in the lower/more normal numbers. I wonder how long he was diabetic? Perhaps not very long? I have high hopes for Twix!
 
Suzanne & Darcy said:
Most of my people end up moving to MPM to keep their cats in the best numbers, but oh my…. Twix is moving so quickly. He is doing great. We don’t have enough information on him yet, but I feel like the token dose of .25 will give him just a little insulin support. You are very fortunate that he is not a cat who bounces up high after being in the lower/more normal numbers. I wonder how long he was diabetic? Perhaps not very long? I have high hoes for Twix!
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I’m not sure. I think there is a good chance we may have caught it somewhat quickly. However, I do know there was a longer delay than I would have normally liked between our initial testing showing indications of DM and his follow-up appointment confirming it, only because of some unfortunate life circumstances. So at the beginning, he was really bad. He looked rough, couldn't hold his bladder, was peeing all over the house, and he has bad neuropathy. But I am so happy we're starting to see results and I can see how much better he is feeling. I appreciate you helping me keep him on track and working on keeping his numbers tight because I do know that is the only way to successfully get him into remission. I certainly wouldn't be navigating this well by myself.

I am not familiar with MPM, but I will start reading up on this method as well.
 
This morning he’s in the 150s. He stayed pretty consistent last night! His shot is due in about 30 min. Referencing yesterday mornings data & considering he’s in the same range, I think we will want a bigger dose than 0.75. Since we still have limited data with him in this range, I was thinking to stay conservative & see how he does with 1 unit?
 
I’ll be interested to see how he does with the 1 unit after you get home and can check the Libre numbers. I admit I am having a hard time figuring out what his actual regular dose is anymore. :confused:
 
Haha, same. I probably could have been giving one consistent dose, and this may be the best course of action moving forward. My vet does think I should give him 1 unit and that I should do a full dose each time and not micromanage it so much. He keeps telling me to look at big picture numbers more and focus a little else on managing every number each day. But he acknowledges that can be hard to do and he’s super happy with the progress.

As we have all determined at this point I am a bit of a nervous Nelly! I’ve clearly been a bit panicky when it comes to giving him insulin in these lower numbers. I certainly can acknowledge that there’s a good chance I am being overly cautious and a bit of a detriment to Twix.

But I’ve been okay with the baby steps… haha
 
You are doing great. We definitely are looking at the big picture in that we try to look for trends and patterns — the overall picture. But there’s one number we do need to focus on and that is the nadir, since if we mess that up and Twix goes hypo it’s bad.

And it takes time for the pancreas to heal and have a good chance at being able to go off insulin and become a “diet controlled diabetic.” For that it takes some time and management to try to keep kitty in the healing numbers. He wasn’t ready for 1 unit just a short time ago, but he may be now… or he may be ready for an even smaller dose :) so let the numbers be our guide.
 
Today his chart was a little more “bouncy” than it has been. But range for day stayed within 50-150 for majority. He did hit lower a couple of times today and looks like he brushed the 50 mark between 11-12. I feel like it’s safe to say his new dose probably is not higher than 1? With him skimming so close to 50.
 
Okay, well this is nice! He’s still a little high, but he pretty much hovered on the 150 line the entire night. There was not much variation at all in his graph. Basically 145-160, a mostly straight line.

However, because it can’t just be that easy lol — Last night I had my friend administer the dose as I watched her bc we are going out of town one evening this week and she’ll be cat sitting, so I was walking her through everything. I say this because I had to correct her w/the injection as she didn’t go in all the way at first with the needle. I believe I corrected her in time before anything released, but also there is chance he didn’t get his full dose. The dose I was giving him was 1 unit again to see how his evening chart looked. If he skimmed low again like in the morning, I was planning to reduce it. But because now I’m not certain he got his full dose, I’m a little stumped on the best dose to try for this morning.

I am under the impression he still needs support, it’s great he stayed on level all night, but we still need him at 100, not 150.

I was thinking I could try 0.75? Or maybe even 0.5… As the 1 unit during the day yesterday was kind of at my max comfort level with his couple of drops right above 50. Which is why I was going to test same dose in evening with me home. But now with this unknown evening variable I’m a little hesitant.

Curious your thoughts.
 
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I tried 0.75 again, even though we did that a couple of days ago and it wasn’t quite enough, his line has tightened up significantly since then. And per trend, I prefer to err on the side of caution.
 
Suzanne & Darcy said:
Also, if you are going to be out of town soon, we may wish to reduce his dose temporarily to be safe.
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Thanks so much for checking in! Twix is still doing pretty well overall. Ideally, I’d like his numbers to be a bit lower and tighter, but I’ve kept him at 0.75 units for a few reasons. I wanted to give it a few days to see how he responded to the steady dose, and since we were away overnight with a sitter, it was safer to keep his dose lower. I also put on a new Libre sensor, which can sometimes read a bit high on the first day due to skin irritation. Without being home to double-check with the ReliOn, I thought it was best to be cautious. However, it does look like his levels are trending up a bit at 0.75 units, so I’ll monitor today and, if needed, may consider increasing back to 1 unit. With the 1 unit, he was skimming the low end of numbers which was making me nervous, but hard for me to determine if he needs higher or just time to feel out this dose.
 
Darn... I think I may have pinpointed the problem. I was using Fancy Feast Natural Pates originally because a list I had referenced showed them as low in carbs. The other day, though, I needed food before the pet store opened, so I picked up some of the Fancy Feast Classics, which I thought were also marked as low-carb on the same list. But after doing the math today to check their phosphorus levels too, it turns out these varieties may be higher in carbs than I thought. I'll have to investigate a little further and go grab some different ones for his feeding tonight. I will probably keep him on the same insulin dose and only adjust the food so as to only change one variable at a time.

I purchased the Classic: Savory Salmon Pate, Ocean Whitefish & Tuna Pate, and Cod, Sole & Shrimp Feast Pate. Fortunately, he's only had two days of these. I'll stick with what I know was working and revert to the Fancy Feast Naturals and ensure I am investigating this better.

I may adjust him to another brand. I've heard good things about Tiki and Weruva. I just haven't had a chance to finish reading up on them yet.
 
I feed some of the lower phosphorus Weruva BFF pates. The FF foods are high phosphorus for an older kitty. I feed lower phosphorus to spare my cats’ kidneys. Also, I don’t feed much fish at all due to concerns about Mercury and some other contaminants. Some cats, though, are really addicted to fish and it’s hard to get them to eat anything else. I keep a couple cans of the FF Savory Salmon Feast around to feed if I have a sick cat who doesn’t want to eat. They like it.
 
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Savory Salmon Feast:
How many carbs are in a 3oz can, on a dry matter basis ?
Answer by • Jul 19, 2021
This variety contains approximately 0.6% Carbohydrate content on an as fed basis (2.5% on a dry matter basis).
 
Ocean Whitefish and Tuna:
Answer by • Aug 18, 2018
The carb content of 0.08% is on an as fed basis. It is approximately 0.10% on a dry matter basis.
 
Cod Sole and Shrimp:
This recipe has a Protein content of 59.8%, a Fat content of 22.6% and a Carbohydrates content of 6.2%, all on a dry matter basis.
 
I agree that the Libre sensors have a reputation of not being as accurate both at the very beginning and very end of their lifespan, at least that is the experience of many of our members here. It looks like Twix may need a dose increase back up to 1 unit soon, but if you are following SLGS, the dose should be held for one week (unless a reduction is earned.) If you would like to read up on the Modified ProZinc Method where doses can be adjusted more frequently when necessary, it in the sticky note at the top of this forum on ProZinc dosing methods.
 
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Thanks Suzanne! I did a quick inquiry with ChatGTP to calculate the carb numbers right before stepping out to run an errand, and I hadn't gotten a chance to check its validity yet. It had them listed over 15% so I was like "oh no!". I know there's a sheet somewhere on here that tells you how to calculate the carbs so I was going to cross-reference it. But you have answered all that for me. This is great, because I could have sworn I researched that prior to purchasing those choices!

Also thank you for this list of foods with phosphorus numbers! Now that I am not as overwhelmed and can spend some time researching more I started noticing the phosphorus levels and with all this guy has going on further kidney support cannot hurt.
 
His ReliOn showed him a bit lower than his Libre. I'll do a random spot test again this evening, and then with his AMPS. I work all weekend so I won't be able to do a manual curve until next week.
 
I’ve been maintaining his 0.75 dose. However, during his AM curve today he hit a low of 64 on his Libre, & during his PM curve tonight he hit 53 and stayed there a bit. I did end up feeding him his +4 snack a little early. While it says reduce when it hits below 50, that feels pretty close to me. However it also states if you see a smiley face graph with a 50% drop to maintain the dose a bit longer. So I’m slightly torn on best course of action.

I’m inclined to want to see how he reacts to a reduction to 0.50 tomorrow, as I will not be home during the day to monitor him.
 
Suzanne & Darcy said:
Here’s an up to date food list for Diabetic cats with CKD (so low to moderate phosphorus food which are also low carb.). That is not to say your sweetheart has kidney disease, but it is a helpful list that I use to find foods for my cats.
https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf
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Alright! Twix has been hovering at the 100 line since about 1:30 am. I think either way he earned a reduction because he hovered in the 50 range much longer than normal last night.

But now I’m not certain if an adjusted dose to 0.50 or an even smaller token dose (0.25) is most appropriate for his 6:00am shot…
 
Looking at his SS. Those numbers from last night are not color coded correctly. They are not supposed to be lime green. Anything 50-99 is dark green.
 
Samantha Styles said:
Hmm, it auto colors in the spread so I’m not sure why it’s showing up a different color. I’ll see if I can fix.
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Usually if you put more than one entry into the spreadsheet you have to manually color code it. Was your spreadsheet set up as an Alpha Trak spreadsheet? That is the only thing I can think of because with an AT meter anything under 68 would automatically be lime green.
 
Suzanne & Darcy said:
Hos whole day yesterday was just the most incredibly amazing beautiful day! I am so impressed (although worried about you because how are you getting any sleep?)
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Wasn’t it beautiful!? His daytime was great. Even his PM was nice. I did not get much sleep last night, but being home I’m at least a little less worried. When I’m at work and I can remotely check his numbers I would probably be pretty nervous either way him hovering on the 50 line.

But I trust these methods work and that I should ask and stick with what you advise because it’s been working. I’m just not able to look at everything as objectively.

I just am getting ready to go downstairs and get his ReliOn reading for him morning routine. His Libre is currently reading 102.
 
Suzanne & Darcy said:
Usually if you put more than one entry into the spreadsheet you have to manually color code it. Was your spreadsheet set up as an Alpha Trak spreadsheet? That is the only thing I can think of because with an AT meter anything under 68 would automatically be lime green.
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I may be color coding the manuals wrong. My phone colors are different than my computer colors haha. I’ll try to take a look at it later see if I can fix!
 
Remember that 50 is a good, healthy number and being in the 50s and other dark greens can help his pancreas to heal. I totally understand your anxiety. That is so cool that you can check BG when you are not at home! I thought you had to be there to scan it.
 
What we want to do is to learn his patterns so when you are not around you can feel confident that he stays in the greens without diving below it. Did you give him any high carb food or anything when he was in the 50s last night?
 
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