? New member: dosing advice, bounces, flat curves... we need help

CHIARA

CHIARA

Member
Hi Everyone,
I apologize for my English, I hope to be understandable.
I'm really in difficult with Nala's diabete: she bounces a lot, when it happens the BG drops in the first few hours after shoot and quickly rebounds to 400. The next cycle (or the next two cycles) is/are flat around 350 until the BG drops again.
I tried to mantain the dose, to increase the dose (it seemed to me to get worse, but the last Vet told me to increase looking only the PS BG), so now I'm trying to mantain a reduced dose even if we had 2 flat curves (I think we are still in a bounce).
I' am afraid to have passed the right dose when I started to feed Nala with low carb wet food (until 10 January I've fed her with dry diabetic food, I didn't Know how many carbs it contains)
I'm a little lost and worried about Ketones, even though Nala is fine right now.

Thank you so much for your help and again I apologize for my English, I hope the spreadsheet in the sign works.


Chiara
 
Hi Chiara,
Sorry you are having a difficult time with Nala. I know what it feels like!

Hopefully someone more experienced than me will be along to help soon but they will need to look at your spreadsheet and I don't think it is set up quite fully at the moment. I wasn't able to see it when I clicked the link in your signature.

The spreadsheet instructions are here:

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

As the instructions say you need to publish the spreadsheet to the web and then give the link to the published SS in your signature. Hopefully that all makes sense!.
 
Hello again, Chiara. I am happy the spreadsheet instructions I sent you in the PM helped you out. Let me get a look at it now to see what I can see.
 
CHIARA said:
am afraid to have passed the right dose when I started to feed Nala with low carb wet food (until 10 January I've fed her with dry diabetic food, I
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Do I understand that you are now feeding her dry food? Or now you are feeding her the low carb wet food and before you were feeding dry food. You changed to low carb wet food on January 10? Is that correct?
 
I think you have been doing a good job taking care of Nala. I would like to find a stable dose for her and try it for a little while. I would like to try the Modified ProZinc Method for Nala where we can adjust her dose a little more frequently and we will not reduce her dose unless she drops below 50. I would like to try 1.5 units.
Now, having said that, are you at home with Nala quite a bit of the time or do you need to be away from him for long periods of time?

Also, what is her feeding schedule? Are you feeding her after nadir (or about +6 or so? Which means are you feeding her much food after about 6 hours after the dose of insulin?)
 
Suzanne & Darcy said:
Do I understand that you are now feeding her dry food? Or now you are feeding her the low carb wet food and before you were feeding dry food. You changed to low carb wet food on January 10? Is that correct?
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Hi Suzanne and thank you so much,
The second one, that is correct: now I'm feeding her the low carb food (2%, 6%, 8%, 10%... I choose based on her BG) and absolutely no more dry food since 10 January.
 
Suzanne & Darcy said:
I think you have been doing a good job taking care of Nala. I would like to find a stable dose for her and try it for a little while. I would like to try the Modified ProZinc Method for Nala where we can adjust her dose a little more frequently and we will not reduce her dose unless she drops below 50. I would like to try 1.5 units.
Now, having said that, are you at home with Nala quite a bit of the time or do you need to be away from him for long periods of time?
Also, what is her feeding schedule? Are you feeding her after nadir (or about +6 or so? Which means are you feeding her much food after about 6 hours after the dose of insulin?)
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I trust you, I can't do it alone.
This morning I've just shooted her 1,5U.I. and I'm going to study the Modified ProZinc Method.

I should go to work during the day, but I'm self-employed, so sometimes I can stay at home if necessary.
But we are lucky, my mother is very next to us for the next months, so if I absolutely can't stay at home, she can take care of Nala and check her BG. I give her instruction by the phone if Nala drops quickly.
Because this is what scares me: when she starts to drop she does it very quickly, when I see BG falls (100-120-140 in 1 hour) I start feed her. But if i were asleep? During the night I'm starting to not hear the alarms... and if she has dropped 60/50 overfeeded, I'm afraid not be able to help her, because I'm sleeping...
She' is underweight, she weights 4,3kg but she should weight 5,5kg and she eats everything I give her, but does not assimilate. She is so good and sweet...
However, when Nala drops quickly I feed her trying to "slow down the fall" and I overfed her.
I ordered medium carb food (12,6%, 14%) to use it during the falls, Is it right or is it a mistake?

Yes, I feed her after nadir
Now reading your words I feel a little bit silly, but I'm guilty. I've done it during the last cycle... and I obviously made a mistake.
Vets told me she should have free access to food so she can regulate her BG with prozinc by herself, I can't do this, because I have 3 other cats and because Nala is perpetually hungry, but I give her food even after nadir... small portions.
If you tell me it is wrong I won't do it again.
Another reason are chetones, i have a blood ketometer.
I checked her in January and she arrived to 2,8... going around and playing with other cats...(I checked ketometer on me and on other cats and it worked) i called vet ER and they told me not to take her until she felt bad.
Feeding her, chetones went down... so I think I feed her even when I shouldn't... it makes me feel safe, but surely I wrong.
The vet checks her urine and there weren't chetones.
Maybe I should start checking ketones again even when Nala is fine... but it scares me. I should try to check it in her cat litter box, following her in the bathroom, even if she doesn't like to be observed.

Sorry for all my questions and thank you very much, and if I'm not understandable, please tell me and I will try to explain me better.

Let's see how 1,5 u.i. will work today.

Have a nice day.
 
You should probably check her ketones daily for a while. If she has ketones over about 1 then you should feed her more because food, water and insulin are important for getting ketones down. You have already seen that yourself when you were feeding and testing her. It would be good of she could eat a lot before her nadir, but for right now if she’s starving and has ketones then let her eat low carb food.

You are not wrong to get different carbohydrates for her. We do not want her dropping 100 in an hour. That is too much. Try to see if 8, 9 or 10 percent will slow her down. Some cats need to start their day with a breakfast of a little more carbs. Let me look at her spreadsheet again to make some suggestions. When do you find her dropping quickly? At what time of day?
 
Thank you, Suzanne.

I choose 10 to slow her dropping, if she is dropping more than 2 points/minutes, but it is not enough... I had to overfeed her too much, so I've ordered 12 and 14 (just for emergency). I'm worried about tomorrow, in the last weeks she dropped after flat cycle (and we are in now) just in the first hours (usually). But she could have another flat cycle too, so I don't feel confident to give her a higher breakfast (it should be too much if she doesn't drop). I think tomorrow I'll checked her since the first hour, trying to catch the drop feeding her.

I will test ketones daily, last cycle she had 0,3 in 8th.. not bad for Nala, i didn't feed her. Now she is sleeping on me really well, she has played a lot despite of high BG , I gave her one teaspoon food in water 4 hours ago, but I prefer let her sleep now, I think she's fine. I ordered ketostrips for urine too, I will try to check it. I can't understand this flat cycle, she isn't bouncing... I'm confused.. should be insulinoresistance because prozinc is not right for Nala?
Thank you so much, for everything... Have a nice day
 
I find Nala with PS 117, I couldn't stall, but I'm here to monitor her BG. I reduced the dose and shoot 1,25 u.i.. I based on past data. Have I wrong?
What should I do the next cycle? I've been shooting 1,5 for three cycles, but now I reduced... Obviusly it depends from the cycle we are in, but I'd like to have some advices, thank you so much
 
CHIARA said:
I find Nala with PS 117, I couldn't stall, but I'm here to monitor her BG. I reduced the dose and shoot 1,25 u.i.. I based on past data. Have I wrong?
What should I do the next cycle? I've been shooting 1,5 for three cycles, but now I reduced... Obviusly it depends from the cycle we are in, but I'd like to have some advices, thank you so much
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I think you did fine. She headed right into a bounce so it’s a shame, but there is no way you could have known when that bounce would begin. I was going to suggest that you increase her to 1.75 after 6 cycles on 1.5 and it still is not a bad idea except I would like to know if you have some of the different carbohydrate food and what kind — and of course I would like to know if you will be able to monitor her cycles. We have not talked about your schedule yet — so I do not know these things.
 
You told "She headed right into a bounce so it’s a shame", do you think we could have avoid it (or get the curve better) shooting her higher dose? I'm just trying to understand how it works.

I feed Nala with 2/4/6/8/10 carb food, I used higher ones (8/10 to manage her drops) and I prefer 4/6 when she is making ketones (blood, never find - fingerscrossed- ketones in urines). I choose based on past data, when I tried to give Nala 0% or 2% carb food, ketones stayed over 1,1 even after I fed her, so I choose higher food (I don't know if it is clear)
I ordered 12/14% carb food to control better her drops. I'm talking about wet complete food. I don't know if you need to know the brands (neither if mentioning brands is ok with forum's rules or if we have the same brands). I try to keep fat under 5% because of her liver (she had beginning of hepatic lipidosis and high transaminases in december. We repeat blood test in January and transaminases was getting better. By the control addominal eco in february the liver was a little irregular again). So I'm trying to keep fat lower than 5%.
I have at home higher carb food (22%), too and honeyand a supplement with glucose syrup in case of hypoglycemia (I think I can call it a Hypo toolbox).

I don't have a fixed schedule: obviously we shoot at 8am and 8pm.. even if I should come back to 7/7 (I stalled past weeks), I was thinking to gain 5 minutes every cycle, do you think is it a good idea making it now?
However, I don't have a fixed schedule.
During the day I have solutions to not let Nala stay alone: when I'm out for job, my mother is very closed to me and I train her use glucometer, during the drops I give her instruction by phone.
During the night my husband and I do our best.
I don't know if I ve been exhaustive, if not please tell me.
 
Update: Nala PS was 67, I waited an hour without feeding her and BG rose to 116, so I shooted 1,5 (slim dose).
The next cycle will be the seventh after the increase to 1,5. The nadir was 67 today...In your opinion should I hold the dose for additional cycles? Sorry to bother you, thank you so much
 
Nala is doing a bit better on the 1.75 unit dose. I hope she will have a good cycle today. She is having good nadirs, but I hope to see her other numbers come down as well. You are doing a good job with her. Her AMPS this morning was not bad at 230. I hope this means a good day for her.
 
Thank you Suzanne, today we had some blue, so I think it has been a good day.
Can't understand her first 3 hours.
Surely I made mistakes with snacks: I think I overfed her during 2nd-3th-4th hour.
Tonight Nala is going to have her 6th cycle on 1,75 U.I..
I'm afraid overfeeding her I falsed the BG numbers, so I can't decide if I have to increase the dose tomorrow, because I don't like her first hours, perhaps she needs the dose held longer. I know i should wait the next cycle before talking about tomorrow, but I think it will be a flat one.

Thank you again
 
It’s okay. Just try feeding her less food then. I really think you should try to feed the foods you have with the least amount of carbohydrates in the first few hours. And try now feeding her anything until +3 (three hours after her breakfast and shot time.). And make it lower carb. It looks like she is getting too much of what we call a “food bump” (which just means going up from food.). What do you think. Will you be at home tomorrow? Can you also try that tonight? Wait to feed her a little longer and feed lower carbs. Save the higher carb food that you ordered for when she seems to be going down rapidly.
 
Oh, I was asking about tomorrow because I was thinking you would like to try another day on this 1.75 dose and try feeding less of the small snacks and making those snacks be very low carb.
 
Suzanne & Darcy said:
It’s okay. Just try feeding her less food then. I really think you should try to feed the foods you have with the least amount of carbohydrates in the first few hours. And try now feeding her anything until +3 (three hours after her breakfast and shot time.). And make it lower carb. It looks like she is getting too much of what we call a “food bump” (which just means going up from food.). What do you think. Will you be at home tomorrow? Can you also try that tonight? Wait to feed her a little longer and feed lower carbs. Save the higher carb food that you ordered for when she seems to be going down rapidly.
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ok, I don't know if I have understood.. I try to repeat
Tomorrow i have to give her food (main meal and until +3) with lower carb, is it correct? If she seems to be going down rapidly, I give her higher food. I'm afraid, because sometimes, with the same food,1 st hour BG is lower than PS. If it happens i will feed her. Ok, I was talking with my husband about that, today (lower carb food during main meals) as you tell me, even snacks. Ok. Thank you very much.
 
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Suzanne & Darcy said:
Oh, I was asking about tomorrow because I was thinking you would like to try another day on this 1.75 dose and try feeding less of the small snacks and making those snacks be very low carb.
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Yes, this is the plan. Not properly.
My plan was this:
I would have like to feed Nala with 1,9% carb during the main meal, increasing a bit the amount (less calories and she is underweight)
Checking her at first, second, third and fourth hour, I would have like to give her snacks ("20 g low carb food) choosing the carb percent based on the BG. I though this because sometimes her first hour BG is lower than PS... even with the same carb and amount.
Even today, despite of snacks (too much), her BG went down 90 points between 2nd and 3th hour... I know is not 100, but between 8th and 9th it shot up from 167 to 297, and pmps was 435.
I don't know, probably I think wrong, but i feel i have to slow down BG going down at the beginning of the cycle, to slow down BG going up at the end of the cycle.

Suzanne, sorry, I apologize... for my english, for my doubts and because i'm afraid.

Edit: even now BG... 1st +25 (not BG peak) 2nd -93 ... i was preparing her snack and she stole other cat food, I don't know the amount... I don't know what i have to do... I gave her a 20g (4,5%) snack... I'll test her at 3th hour, this BG is unpredictable
 
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Even today Nala's BG went down 80 points between 1st and 2nd hour and 97 points between 2nd and 3rd. And after straight to 400. In my opinion it depends from the drop. I'm going to hold the dose tonight and perhaps tomorrow (even if i know i should increase) because I'd like to split Nala's main meal, giving her 70g before the shoot, 30 at the 1st hour, 20 at the 2nd and 20 at 3rd. She should weight 5,5-6 kg, now she is 4,3 kg... She's young, I think 280 g of food is right for her. I hope to slow down BG doing this. Is it a crazy idea and am I definitely going out of my mind?:oops:
 
CHIARA said:
ok, I don't know if I have understood.. I try to repeat
Tomorrow i have to give her food (main meal and until +3) with lower carb, is it correct? If she seems to be going down rapidly, I give her higher food. I'm afraid, because sometimes, with the same food,1 st hour BG is lower than PS. If it happens i will feed her. Ok, I was talking with my husband about that, today (lower carb food during main meals) as you tell me, even snacks. Ok. Thank you very much.
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Yes, of course if you see that she is dropping quite a bit then you would go ahead and feed her. You have to adjust things depending on how her BG is going. I was talking about these days when she seems to stay stuck in pink for the first three hours of the cycle—that you can try feeding her less carbs and try moving the first snack to a little later (maybe +3). It was just a suggestion. I am sorry if it is confusing. These things are not “hard and fast” rules, because they have to be individualized for each cat (made to fit your cat and her own particular patterns.) And sometimes your cat has one pattern and sometimes another (sometimes she drops quickly and sometimes stays high and flat in her numbers.) I am trying to discern of the cause of her staying in pink for the first three hours or so is because of food amount and/or carb amount. Also, I do not want her to not get enough food if she needs to gain weight. That is very important for her to get enough calories so you will have to tell me if you think she is eating well or not.
 
CHIARA said:
I don't know, probably I think wrong, but i feel i have to slow down BG going down at the beginning of the cycle, to slow down BG going up at the end of the cycle.
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You are correct. This is exactly what we want to do. Slow down her dropping at least a little bit. It is okay if she drops 80 points in one hour. We just don’t want it to be 100 or more. Also, if she keeps doing it every single hour that would not be good. So you feed her according to her BG. I just don’t want you to slow her down too much. It is a learning process to see what works for Nala. Okay? I think you have the right notion of how to do this. Some cats do reach their nadir early (at about +4) so you don’t really want to feed much after nadir. It should be small if necessary and low carb. I think you understand this already, but I am trying to be thorough in my replies.
 
Always thank you Suzanne... I feel I'm not alone, thank you.
I start with 2% carb during main meal (70g), and after i'm going to make decision about carbs based on her BG, as you told me. I think red is hormonal, BG goes down and if it happens too quickly, BG spikes to 400 and stay flat for some hours..
Thank you so much for your words, always.. I' m sorry if i have trouble understanding
 
Wait. I am not seeing exactly what you are talking about on the spreadsheet. I was looking at today March 1. It was a pretty good cycle. Let me look at it again and tell you what I see. She did not start to drop until +3 when she went into yellow. It looks like today she should have had the normal +2 snack instead of waiting until +3. I am sorry. Maybe this is just getting to be too much work for you. And you don’t have a crystal ball to look into to see where her BG will be in the future.
 
Today this is what I see on her spreadsheet. This is just for me so I can look and comment on it without having to go back and forth between this thread and the spreadsheet.
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Suzanne & Darcy said:
Wait. I am not seeing exactly what you are talking about on the spreadsheet. I was looking at today March 1. It was a pretty good cycle. Let me look at it again and tell you what I see. She did not start to drop until +3 when she went into yellow. It looks like today she should have had the normal +2 snack instead of waiting until +3. I am sorry. Maybe this is just getting to be too much work for you. And you don’t have a crystal ball to look into to see where her BG will be in the future.
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I feed her at 2nd (when I saw BG was 324) and after in 3rd (when I saw BG was 223). Now I' ve given her 70g PS and the rest of main meal after 1 hour. Do you think feeding her every hour for the first three hours is wrong? (if it is necessary, obviously) Sorry
 
She dropped 101 points between +2 and +3, which is quite a normal time to see such a drop, but it is a little faster than I would like. I think a +2 small meal was good today. It looks like she needed a few more carbs, but how could you know that at the time? I am sure you were trying to make sure that she would not stay in the pink. Anyway…. After thos…. She dropped 101 points between +2 and +3 so that would be the time where you were aware that she needed more carbs at her +3 snack and I see that you already did that (perfect!) You did succeed in slowing Nala down between +3 and +4 as she dropped a reasonable amount of 56 points and then another 55 points (also good) in the next hour…. and, after that, she stayed stable in blue for another hour before rising. I am very impressed with how you managed this cycle. She had a very nice cycle today. She rose up more quickly than we would like in the afternoon, but that happens. We can only try and control so many variables. Food carbs and timing are our only real ways of trying to help make the cycle a good one. We can’t control other things that Nala’s body will do. You are helping her to be more healthy and things will get easier and she should become more predictable as time passes. Don’t worry. She is already much healthier just by receiving insulin and having you to care for her.
 
CHIARA said:
I feed her at 2nd (when I saw BG was 324) and after in 3rd (when I saw BG was 223). Now I' ve given her 70g PS and the rest of main meal after 1 hour. Do you think feeding her every hour for the first three hours is wrong? (if it is necessary, obviously) Sorry
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I do not think it is wrong. It is fine. The trick (difficulty) will be in deciding how many carbs to give. Too much and she doesn’t go down when she should. Too little and she drops a bit too fast. Nothing is a disaster if it happens. Like today, she could have eaten more carbs at +2, but nobody would know that until +3. But even with the 101 point drop, she still had a nice cycle. So it’s all right. You are doing well. I am pleased. I am guessing that Nala is already feeling better and is happier than she was when she was in December when she was diagnosed?
 
Thank you so much.
She was diagnosed 5th december, we tryed to manage diabete without insuline for 10 days, giving her diabetic food, she had rynotracheites and didn't want eat. She preferred dry food... and she had to eat, even because she had a beginning of lipidosis. We were in a move (changing house), she had just lost her dog-best friend.. she was stressed, an horrible moment. We started with prozinc 15 december, with dry diabetic food and Nala's BG was on 550-500. I started to get informations, so we have changed food (only wet low carb) and I started to try to manage her cycles... Now she feels better than January also, she is not lethargic.. she feels better. Thank you so much, I'm doing my best, trying to help her.. Let's hope March is an even better month. I try to prevent her BG based on data and on my feelings.. I know perhaps it is a stupid thing, but that is. I think I will never be able to stop thanking you.
 
CHIARA said:
Thank you so much.
She was diagnosed 5th december, we tryed to manage diabete without insuline for 10 days, giving her diabetic food, she had rynotracheites and didn't want eat. She preferred dry food... and she had to eat, even because she had a beginning of lipidosis. We were in a move (changing house), she had just lost her dog-best friend.. she was stressed, an horrible moment. We started with prozinc 15 december, with dry diabetic food and Nala's BG was on 550-500. I started to get informations, so we have changed food (only wet low carb) and I started to try to manage her cycles... Now she feels better than January also, she is not lethargic.. she feels better. Thank you so much, I'm doing my best, trying to help her.. Let's hope March is an even better month. I try to prevent her BG based on data and on my feelings.. I know perhaps it is a stupid thing, but that is. I think I will never be able to stop thanking you.
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She is going to be even better in March! I am sorry about your dog and about Nala also being sad because of that loss too. It is very hard for us to see our pets grieving (even as we are also grieving.)
 
Yes <3...
Nala is probably giving us a nice cycle, fingers crossed.
Tomorrow I should increase the dose, I think.
But I'll wait until the end of this night cycle to decide.
 
It seems to me Nala's cycles worst with 2.0 u.i., I know (?), better if I say I think I should wait a few other cycles, but sometimes I feel a little discouraged. I can't see any drops last cycle, I can't understand why her BG is so flat over 400 today. I'm not feeding her because her ketones are 0,4 even if she doesn't drink and I would tempted to give her a bit of food with water, but I don't want to risk to do worst. If I' ve made (or if I'm making) some mistakes that you can see, or if there is something i should do, please tell me... always thank you
 
She does need more time on this dose for us to see how low it will take her BG. It’s very common to have a few good cycles followed by some high flat cycles. She will drop down, and we will see how low the 2 units will take her. Be patient. Please feed her according to her regular schedule. She needs the food and, if you give her low carbs, it will have very little impact on her BG. It’s more important that she eat. Her body is having a reaction to the lower numbers she had before (the blue numbers) and we must give her time to come back down. All right?
 
I see she has come down a little into a lot of yellow numbers. That’s a little better, but she seems stuck in those 200s. Still… we have to wait a bit longer.
 
Yes, I was thinking to held the same dose until something happens, surely tomorrow... let' se what will happen. The positive is that Nala has been with BG's values under 300 for 2 consecutive cycles (usually she has one good cycle and one flat cycle over 350). I dream the yellow numbers become blue tonight, let's hope! (it doesn't cost)
Thank you very much for your advices, so much.
 
Hi, I need advices...
It seems to me that the current dose (2.0 u.i.) isn't working very good. I was thinking to reduce the dose at 1,75, because of Nala's "dropping". I'm confused and tired, because she has dropped during the last two night... perhaps I should have held for more cycles the previous dose (1,75) to reduce her "dropping" (and the consequent bounce). I don't know which is the better choise. Thank you very much.
 
Don’t be upset. She’s making progress. Please don’t reduce the dose. I see she’s been in blue numbers and is having blue tonight.
 
Look at how she was blue last night and had one high cycle and is back in blue tonight. This is progress and shows how her body is starting to adjust to blue numbers.
 
No, no... I'm not upset... if you think she's making progress I believe... I'm not understanting very well what's happening, Ok we keep the dose, thank you... I will try to manage better her BG dropping... probably I'm not able to dose carbohtdrates, thank you again
 
Suzanne & Darcy said:
Look at how she was blue last night and had one high cycle and is back in blue tonight. This is progress and shows how her body is starting to adjust to blue numbers.
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If I watch her SS... it seems to me that before was better, even if I had to increase following the method, so perhaps until I'll find the right dose it will be complicated
 
CHIARA said:
Between 2nd e 3rd hours.. (301-182 and 368-244)... and i gave her food, but without food? I'm really worried about her dropping, it seems to me so quick, I can't understand if it is normal, why does it happen?
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It’s just the insulin starting to lower her BG. Those last two nights— how did you feed her?
 
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