? Is his dose too high?

Christine&Arnold said:
My cat Arnold is on ProZinc and right now he is getting 2.5 units. I was wondering, if maybe that is too much? His numbers are fluctuating a lot and I am kind of getting a little bit discouraged. I know it takes a while before it works, but I am worried about him.
Here is his SS

https://docs.google.com/spreadsheets/d/1MgIJPlyXPJRBf2UAaF1VvIGCUUYmRWlCXzNnZd5n4ew/edit?gid=0#gid=0

Christine & Arnold
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Hello, Christine.what is worrying you the most about Arnold right now?
 
About his dose, his spreadsheet data doesn’t show that he is at too high of a dose. Since he is new to insulin and you are following SLGS, you don’t reduce the dose unless his BG drops below 90. That doesn’t mean that numbers below 90 are dangerous. It just means that with the SLGS dosing method, the goal is to try to keep the nadirs between 90 and 150. It will be better for Arnold if, after a bit, we switch him to the Modified ProZinc Method because we can probably get some of the higher numbers down by getting his nadirs down. With MPM we would reduce the dose if Arnold dropped below 50. He probably needs more time to adjust. We actually can switch him any time because you do plenty of testing to keep him safe and track his nadirs.
 
Suzanne & Darcy said:
Tell me again how you are feeding him? Is he getting a small amount of LC wet food at +2 and +4. Those snacks of a teaspoon or two of LC wet food are important.
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He has access to LC wet food at all times, since he is used to grazing. He also lost a significant amount of weight before he was diagnosed. I have him on MAC'S wet food, which was on the SS with recommended foods for UK/EU.
I am mostly worried about his fluctuating numbers but I guess his body isn't quite used to it yet.
 
Okay. Well we can try to keep him grazing then since the poor baby is underweight. Eating much after nadir can shorten the duration of the insulin and make numbers rise prematurely. We won’t worry about that right now. What is important is that he’s not supposed to eat for two hours prior to shot time. The reason for this is that, if he has eaten his BG number will be higher because of food. So you don’t have an accurate fasting BG number to know if it’s safe to shoot the insulin or if a reduced dose is perhaps needed. If you have a really good idea of how much his BG rises after he eats, then we can still make decisions on dosing. I guess, again, his preshot numbers are so high that maybe it doesn’t matter much …. Later on it could be important if you are shooting a low blue or a green number.
 
Okay so I see that today he has earned a reduction down to 2.25 units due to hitting 65 today. Just saw this on his SS.

so looking at his spreadsheet for today…. He dropped a LOT from his AMPS in just a few hours. This is too much of a drop. If he weren’t free feeding, I would have said to make sure he eats at onset time, which is usually two hours after the shot. That would have slowed him down a bit and hopefully kept him from dropping to 65 at +4. He should eat again at +4. Do you have any way of making sure he eats a little at these times. I don’t know if you can encourage him to eat at these times or not…. I am just asking. Is his appetite good?
 
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Suzanne & Darcy said:
Okay so I see that today he has earned a reduction down to 2.25 units due to hitting 65 today. Just saw this on his SS.

so looking at his spreadsheet for today…. He dropped a LOT from his AMPS in just a few hours. This is too much of a drop. If he weren’t free feeding, I would have said to make sure he eats at onset time, which is usually two hours after the shot. That would have slowed him down a bit and hopefully kept him from dropping to 65 at +4. He should eat again at +4. Do you have any way of making sure he eats a little at these times. I don’t know if you can encourage him to eat at these times or not…. I am just asking. Is his appetite good?
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He has gained a healthy appetite, and I offer him Hills m/d wet food when he is lower because I am scared of hypo. I only have hills wet food with higher carbs at the moment, but I should be getting loads of snacks for him next week. 1 of the times he has been low, he was acting hungry (doesn't mean it is always low, but I check when he is restless). He will have periods of rest when his BG is lower than what he is used to, Be very active and lash out at my other two cats when it is high. He sometimes wake me at night and I always make sure to check him there and see if he has food after checking his BG. He seems to walk okay, he has never been the most athletic or graceful cat but nothing out of the ordinary. I will try and start checking him and take his food away 2 hours before PS. I should give him 2.25 next dose?
He has gained 600gr. since he started insulin, so it seems to be working in that regard.
 
Since Arnold has gotten some green numbers on his current dose, you need to be able to monitor him carefully if you do an increase. Technically, he has earned a reduction when he dropped below 90 — according to SLGS dosing method. The problem is that he is still eating some dry food which can make BG numbers somewhat unpredictable (even though he is still only getting a small amount.) So if you would like to see some lower green numbers what you could do is put in your signature a custom reduction point of something lower than 90. Your could consider a reduction point of 75 or 80 — maybe even 70. Like I said, you have already seen some green numbers on his current dose, although most of them were higher greens. I don’t think increasing will put him in danger if you can monitor his cycles. I would still wait the full 7 days and do the increase on Monday and not tomorrow.
 
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I see you already did the increase. I am sorry I didn’t get my replies back to you in time. I would have given it the full seven days according to the SLGS dosing method. Monday would have been the 8th day and the time to do the increase.

Sometimes you do not test at night. I hope you will test tonight. It’s important to find out how low he goes at night because it’s not always the same as the day. Many cats drop lower at night. I think he is doing this possibly ad that is the reason for his red AMPS on many occasion.
Hold this dose for 7 days unless he drops below your reduction point (which I mentioned above - let me know what you think is a reasonable reduction point.). Remember, we are most concerned about his nadir (how low the dose is taking him) because that is the difference between being safe on a dose or risking a hypoglycemic event. I know the high preshot numbers are very frustrating.
 
Suzanne & Darcy said:
I see you already did the increase. I am sorry I didn’t get my replies back to you in time. I would have given it the full seven days according to the SLGS dosing method. Monday would have been the 8th day and the time to do the increase.

Sometimes you do not test at night. I hope you will test tonight. It’s important to find out how low he goes at night because it’s not always the same as the day. Many cats drop lower at night. I think he is doing this possibly ad that is the reason for his red AMPS on many occasion.
Hold this dose for 7 days unless he drops below your reduction point (which I mentioned above - let me know what you think is a reasonable reduction point.). Remember, we are most concerned about his nadir (how low the dose is taking him) because that is the difference between being safe on a dose or risking a hypoglycemic event. I know the high preshot numbers are very frustrating.
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I will try and hold the dose 2.25 for seven days and try and test him more during the night. I just felt like his numbers were high, even at the time his nadir is. He is still not very happy about only getting wet food, so I have been putting very little pieces og dry food in it to get him interested in the food. He will act very hungry, even though he has wet food available which can be a little frustrating.
 
Christine&Arnold said:
I will try and hold the dose 2.25 for seven days and try and test him more during the night. I just felt like his numbers were high, even at the time his nadir is. He is still not very happy about only getting wet food, so I have been putting very little pieces og dry food in it to get him interested in the food. He will act very hungry, even though he has wet food available which can be a little frustrating.
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That is frustrating, and I completely understand, as I have cats who can be like that. You might want to investigate a different “food topper” like ground up freeze dried pieces of chicken (I use Pure Bites but there are others - pure meat chicken or other things like salmon which have been freeze dried so they can be ground into a powder.) Another thing I use is Bonita Flakes (either from a supermarket or an Asian food store or they are also sold by pet food retailers.) I crumble some on top of the wet food.

What do you give him for treats when you test his BG?
 
He even had a nadir of 63 on this dose 28 February. That’s the lowest one I see recently, and that is when he would have earned a reduction. It’s true that some days he is bouncing from the previous low numbers that he’s not used to yet — so he doesn’t have a green nadir — and some days not much of a nadir at all — but it’s the days that he’s dropping into green that we need to watch.
 
Suzanne & Darcy said:
That is frustrating, and I completely understand, as I have cats who can be like that. You might want to investigate a different “food topper” like ground up freeze dried pieces of chicken (I use Pure Bites but there are others - pure meat chicken or other things like salmon which have been freeze dried so they can be ground into a powder.) Another thing I use is Bonita Flakes (either from a supermarket or an Asian food store or they are also sold by pet food retailers.) I crumble some on top of the wet food.

What do you give him for treats when you test his BG?
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I don't give him treats when I check his BG, but I should probably look into som LC treats as well
 
Suzanne & Darcy said:
He even had a nadir of 63 on this dose 28 February. That’s the lowest one I see recently, and that is when he would have earned a reduction. It’s true that some days he is bouncing from the previous low numbers that he’s not used to yet — so he doesn’t have a green nadir — and some days not much of a nadir at all — but it’s the days that he’s dropping into green that we need to watch.
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And thank you so much for your time and help! I really appreciate it! :bighug:
 
Suzanne & Darcy said:
We always recommend a treat be given after every single ear prick/BG test — as a reward to keep things positive.
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He is bouncing and his PS numbers are quite high. I am a little worried about him. He is very hungry all the time (He gets between 200-250g of LC wet food spread out through the day), his thirst has increased a bit and yesterday his stool was quite wet. I don't know if I should change the dose or keep it for a little longer and see how he is. I would really like some help or insight on what to do?
 
Hello. I am sorry Arnold is not happy right now. You have seen some greens that were lower greens and yesterday blue on this dose. I would not advise increasing the dose just yet. I think he’s on track to go down into at least blue today. Can he have a little extra LC wet food? Can you add a little water to his food to help keep him hydrated?
 
Suzanne & Darcy said:
Hello. I am sorry Arnold is not happy right now. You have seen some greens that were lower greens and yesterday blue on this dose. I would not advise increasing the dose just yet. I think he’s on track to go down into at least blue today. Can he have a little extra LC wet food? Can you add a little water to his food to help keep him hydrated?
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I also asked in the diabetes support FB group and was recommended to lower his dose to 1.75 to hopefully help with his bouncing. I gave him some extra food and I normally put some water in it because he seem to like his food with a thinner consistency.
 
No. I have no idea who said that, but it is wrong. Apparently they don’t understand bouncing either. What is the theory behind that recommendation? It makes no sense. Don’t they understand that cats can bounce from any numbers (pink, yellow). It’s any time the cat is experiencing numbers that his body isn’t used to — or if he drops too quickly (which is why we use food at strategic points in the cycle.). Lowering his dose now will increase his overall numbers. This will increase his thirst and hunger and cause him to be even less able to utilize the food that he takes in. Also possibly he will have increased ketones. More in a minute. I hope you will not decrease the dose. It will not help Arnold.
 
Which FB group was that? Not the one associated with this Board, I hope. I don’t think any of the mods on our group would give such bad advice. But I do know of another group who gave me some bad advice that I listened to for six months before I found this Board. I hurt my cat listening to those people. This was quite a few years ago now, but they’re still around.
 
I predict he will come down into blue today. Hopefully green. He did yesterday- then he had a cycle of high numbers. This is not a true bounce. All high numbers are not a true bounce. I do believe that his nighttime cycles are showing a reaction to the lower daytime numbers. However, his pattern is to come back down during the daytime. You are actually very lucky because he doesn’t have bounces lasting for days. A lot of people on this forum have cats who, initially, have true bounces that last for 4-6 cycles.

Believe me, I understand the frustration and the real worry when you see your cat struggling with these high numbers and not feeling well. I experienced it myself (and as I said, I got really bad advice and that wasted six months of my boy’s life and left him in high numbers that actually resulted in a DKA and damaged his kidneys.)

The only way to overcome bouncing — or to minimize it — is to let your cat spend as much time as possible in lower and normal numbers. That’s the only way to have their bodies adjust to the lower numbers and not “panic” and release stored glucagon (a sugar) from the liver as well other hormones that serve to increase blood glucose. It is so hard. I have worked with so many people who were in this situation and they certainly had their doubts. I can link some spreadsheets for you if you like so you can see.

Also, the pattern that Arnold is in right now is very common. I am working with some caregivers right now who are in the same situation.
@Shawn & Sir Maximus can you encourage Christine? Shawn’s cat, Sir Maximus, went through a period of lots and lots of bouncing and we had to weather the storms and stay the course until finally Sir Maximus has become a very well-regulated kitty.
 
Even last night, he was not bouncing. He went from 509 to 322 to 284. That is a response to the insulin and is not a bounce. Some of what we are seeing is lack of duration as opposed to bouncing.

Also, the M/D dry food he is eating is 14.2 % carbs. It is raising his BG and making things more difficult to regulate. That is medium carb food and would be a carb percentage that would be used to raise BG if it was too low. I know you said he only eats a little, but a little is all it takes. If he must eat dry at this point while you are trying to transition him, can you look into Dr. Elsey’s clean protein chicken flavor. It’s much lower in carbs and many cats like it a lot? Also the Young Again dry foods like Zero Mature and another one they offer are zero or very low carb.
 
Ah. I found your posts on that FB group. That’s the group that had me spinning my wheels for six months or more. If you want to use FB and not this forum, then you can find some of our great people on the Feline Diabetes group associated with this Board. It is called Feline Diabetes and has the photo of the cat that you see at the top of this page.
 
Now — and sorry for the huge data dump here — I will say that, at times his doses have been changed a bit too frequently. With the dry food on board, you should follow the Start Low Go Slow dosing method and hold the doses for 7 days (unless he drops below 90.) So technically he has earned a dose reduction with those greens he had, but it would be down to 2 units and not 1.75 units. The 1.75 unit dose was only held for a few days and I wasn’t sure why he was increased to 2 units quite so quickly, but I assumed it was the vet who told you to do that.

What I think would be best for Arnold is to cut out the M/D food and substitute a low carb option (best would be to cut out all dry food, but that can be a future goal). You would see his numbers come down. Then, follow SLGS by holding doses for 7 days unless a reduction is earned by Arnold dropping below 90. 90 is not a dangerous number by any means and if you cut out all dry food eventually, we can switch to the Modified ProZinc Method where we can get Arnold into even more healthy numbers in the lower greens (50 and above.)
 
Suzanne & Darcy said:
Now — and sorry for the huge data dump here — I will say that, at times his doses have been changed a bit too frequently. With the dry food on board, you should follow the Start Low Go Slow dosing method and hold the doses for 7 days (unless he drops below 90.) So technically he has earned a dose reduction with those greens he had, but it would be down to 2 units and not 1.75 units. The 1.75 unit dose was only held for a few days and I wasn’t sure why he was increased to 2 units quite so quickly, but I assumed it was the vet who told you to do that.

What I think would be best for Arnold is to cut out the M/D food and substitute a low carb option (best would be to cut out all dry food, but that can be a future goal). You would see his numbers come down. Then, follow SLGS by holding doses for 7 days unless a reduction is earned by Arnold dropping below 90. 90 is not a dangerous number by any means and if you cut out all dry food eventually, we can switch to the Modified ProZinc Method where we can get Arnold into even more healthy numbers in the lower greens (50 and above.)
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Thank you so much for all the explanations. It is very hard because I am still relatively new when it comes to diabetes. I have tried cutting out dry food completely but he will sometimes steal a few bites of food from one of my other cats (I am keeping a close eye on them when they eat but it happens sometimes). I haven't put dry food in his food the last 3 days. I will keep his dose for at least 2 more days and see what his numbers are. Or should I keep this dose for longer?
I just really want to find the perfect dose for him and I know it takes time to find it, I guess I just get a little scared when his numbers get high and stay high even though he gets his insulin. I will try and be more patient and not change his dose as often as I have.
I really appreciate the help :bighug:
 
I can really tell that you are trying to do the very best for him! When my cat became diabetic, I switched all of my cats over to low carb wet food. I already was feeding them a high protein low carb wet food, but I did give them a little kibble and it was not low carb. I found out at that time that the only low carb kibbles were Dr. Elsey’s and Young Again (which I have never tried, but I am about to because for some reason the Dr. Elsey’s price has increased again and it looks like a better value.) I don’t have a diabetic cat anymore, but I still feed them all low carb food. I have a few cats on steroids, which raises BG, and I don’t need to add HC or MC to the mix as well.
 
I do understand about the food stealing! That’s another reason I switched everybody to LC!

Unless I have miscounted, it looks like he will be ready for a dose increase on March 16 (depending upon his numbers, of course.)

If he’s still seeing quite a bit of green, we will need to hold longer.
 
Suzanne & Darcy said:
I predict he will come down into blue today. Hopefully green. He did yesterday- then he had a cycle of high numbers. This is not a true bounce. All high numbers are not a true bounce. I do believe that his nighttime cycles are showing a reaction to the lower daytime numbers. However, his pattern is to come back down during the daytime. You are actually very lucky because he doesn’t have bounces lasting for days. A lot of people on this forum have cats who, initially, have true bounces that last for 4-6 cycles.

Believe me, I understand the frustration and the real worry when you see your cat struggling with these high numbers and not feeling well. I experienced it myself (and as I said, I got really bad advice and that wasted six months of my boy’s life and left him in high numbers that actually resulted in a DKA and damaged his kidneys.)

The only way to overcome bouncing — or to minimize it — is to let your cat spend as much time as possible in lower and normal numbers. That’s the only way to have their bodies adjust to the lower numbers and not “panic” and release stored glucagon (a sugar) from the liver as well other hormones that serve to increase blood glucose. It is so hard. I have worked with so many people who were in this situation and they certainly had their doubts. I can link some spreadsheets for you if you like so you can see.

Also, the pattern that Arnold is in right now is very common. I am working with some caregivers right now who are in the same situation.
@Shawn & Sir Maximus can you encourage Christine? Shawn’s cat, Sir Maximus, went through a period of lots and lots of bouncing and we had to weather the storms and stay the course until finally Sir Maximus has become a very well-regulated kitty.
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Suzanne & Darcy said:
I do understand about the food stealing! That’s another reason I switched everybody to LC!

Unless I have miscounted, it looks like he will be ready for a dose increase on March 16 (depending upon his numbers, of course.)

If he’s still seeing quite a bit of green, we will need to hold longer.
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Suzanne & Darcy said:
I predict he will come down into blue today. Hopefully green. He did yesterday- then he had a cycle of high numbers. This is not a true bounce. All high numbers are not a true bounce. I do believe that his nighttime cycles are showing a reaction to the lower daytime numbers. However, his pattern is to come back down during the daytime. You are actually very lucky because he doesn’t have bounces lasting for days. A lot of people on this forum have cats who, initially, have true bounces that last for 4-6 cycles.

Believe me, I understand the frustration and the real worry when you see your cat struggling with these high numbers and not feeling well. I experienced it myself (and as I said, I got really bad advice and that wasted six months of my boy’s life and left him in high numbers that actually resulted in a DKA and damaged his kidneys.)

The only way to overcome bouncing — or to minimize it — is to let your cat spend as much time as possible in lower and normal numbers. That’s the only way to have their bodies adjust to the lower numbers and not “panic” and release stored glucagon (a sugar) from the liver as well other hormones that serve to increase blood glucose. It is so hard. I have worked with so many people who were in this situation and they certainly had their doubts. I can link some spreadsheets for you if you like so you can see.

Also, the pattern that Arnold is in right now is very common. I am working with some caregivers right now who are in the same situation.
@Shawn & Sir Maximus can you encourage Christine? Shawn’s cat, Sir Maximus, went through a period of lots and lots of bouncing and we had to weather the storms and stay the course until finally Sir Maximus has become a very well-regulated kitty.
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Hi Christine hang in there and stay consistent with your kitty. It takes time and patience but you will see the results. I didn't think I would ever get my boy regulated but finally after a few months his body got use to the low numbers and he stopped the bouncing. I listened to Suzanne and she guided me thru every task that I had and i would of never got him well without her knowledge and expertise. Very thankful for her and everyone in this group.
I have many posts that you can review and see my struggles with him bouncing.Reach out if you have any questions. Looking forward to see good results soon.
 
Shawn & Sir Maximus said:
Hi Christine hang in there and stay consistent with your kitty. It takes time and patience but you will see the results. I didn't think I would ever get my boy regulated but finally after a few months his body got use to the low numbers and he stopped the bouncing. I listened to Suzanne and she guided me thru every task that I had and i would of never got him well without her knowledge and expertise. Very thankful for her and everyone in this group.
I have many posts that you can review and see my struggles with him bouncing.Reach out if you have any questions. Looking forward to see good results soon.
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Thank you so much for the reassurance! I will stay consistent and hope he gets used to it soon!
 
You have seen some good numbers! I am happy seeing the blue and green! I am proud of you for shooting the full dose the night before last (when you got 4 different tests at PMPS.). You did perfectly! It would be really helpful if you would write in the remarks section of your spreadsheet about what you fed him amd how much and when he ate. I am trying to decode some of the trends on the spreadsheet and I have a lot of questions about his eating times and foods. Most people will write in the food fed and the time (the AM/PM +1, +2 etc.). It actually can help you a lot to see how carb sensitive Arnold is / what his response is to different foods/carbs. Be sure to include everything— even if other just ten pieces of kibble.
 
Suzanne & Darcy said:
Bottom line: let’s hold this 2.25 dose a little longer. Are you feeling a little bit better about Arnold now? I know you have been so worried about him. How does he seem to you? :bighug:
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He seems more relaxed and he isn't begging for food all the time. I haven't been weighing his food for the past couple of days (I keep and eye on his weight) and it seems to go better. I usually give him food at the time of his insulin. He will typically run out of food by 5 pm. I haven't checked when he runs out during the night but he will usually wake me up and beg for food at around 6 am. I have 2 different kinds of flavours of the same wet food. I use MAC'S and the % of those two flavours are 3.2% and 3.4%. I alter between them (One can is 800g. and I alter between them when I have to open a new one). I have been made aware of that it is good to have food with different % for when he needs something with a little more carbs but still below 10%
I have found it a little hard to come up with a good feeding schedule since I will be working 2 times a week and I don't want to get him used to a time where I can't be persistent. Right now he gets food at 9am and 9pm. If his blood sugar is in the greens during the day (at around 3pm) I will fill up his bowl a little bit more, so that he has the opportunity to eat in case he gets too low. He has shown signs of hunger (almost panic) when his numbers are in the low greens.
I also make sure to keep and eye on his little stealing habit. All of my cats have a surefeed food bowl, but I make sure my other cat's bowl is near empty at night in case he wants to steal, and during the day I keep an eye out for when they eat and make sure he isn't stealing.
 
Today, for example, he really needed the +2 snack to slow him down a bit. That drop was too steep and could set up a bounce. I hope not, but either way he bottoms out too quickly and then starts going up.
 
Suzanne & Darcy said:
I was just checking in on you and Arnold. Good job feeding the small meals and getting all the tests. Thank you! I see he just made it into green yesterday.
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I was wondering if we keep going with the dose? He has been calm these past day (except today) and have been better food wise (not hungry all the time). I have been tryng to be very persistent with giving only wet food but he will sometimes still complain an try to steal from the others (I supervise while the others eat and they have very small limited amounts at night or of I'm not home)
Thank you for checking in on him
 
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