1/4/23 Bugs PMPS 163, 0.5 dose, +4 86

SKittyMom

SKittyMom

Member Since 2022
@FrostD @Suzanne & Darcy,
Happy New Year!

We've had some lower BG levels (in the green) for Bugs at her PMPS +4 test the last few evenings. I was hoping you could take a look at her numbers. Do you recommend we continue with current 0.5u or make some adjustments?
We've not seen any changes in her behavior, all good there.

Thanks as always!
 
Did you double check that 48?

Typically when they're 40-49 we give high carb wet, no syrup yet. Below 40 we add syrup. No harm in doing syrup + high carb given that drop last night, but remember that syrup is a fast sugar. It only gives you a fast temporary boost, you also need some HC food to help sustain the increase in BG. When you're giving syrup you can test every 10 mins to be sure no further drop, then when giving wet food it's 20 mins. You'll want to keep testing until you're sure she's riding on her own without food for two hours.

Reduce to 0.25U with that 48.
 
@FrostD



If she gets a reading like that again I will hold on the syrup and just give the HC wet food and do the additional testing. Thanks for the info.

We did a test about 45 minutes after and she was at 113.

To confirm, reduce her dose in the am to 0.25 if she has a low BG the evening before? Otherwise continue with the current 0.5?
 
Any drop under 50 is a reduction of 0.25U. So you'll reduce to 0.25U and hold that dose for at least 5 days, at which point you'll re evaluate if she maybe needs an increase. Otherwise, you hold it until she learns another reduction (down to 0.1U).
 
FrostD said:
Did you double check that 48?

Typically when they're 40-49 we give high carb wet, no syrup yet. Below 40 we add syrup. No harm in doing syrup + high carb given that drop last night, but remember that syrup is a fast sugar. It only gives you a fast temporary boost, you also need some HC food to help sustain the increase in BG. When you're giving syrup you can test every 10 mins to be sure no further drop, then when giving wet food it's 20 mins. You'll want to keep testing until you're sure she's riding on her own without food for two hours.

Reduce to 0.25U with that 48.
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If the Covetrus Glucose Monitor is a Pet meter as the spreadsheet indicates and reads like an Alphatrak, I'd definitely be giving syrup between 40-49.
 
@Shelley & Jess it is a Pet Meter. I'm not familiar with the Alphatrak. The meter we have is the one our vet provided. We debated switching to a human monitor but decided to stick with what we are familiar with now.

@FrostD since a pet monitor, should we do the syrup at the 40 to 49 range?
 
SKittyMom said:
@Shelley & Jess it is a Pet Meter. I'm not familiar with the Alphatrak. The meter we have is the one our vet provided. We debated switching to a human monitor but decided to stick with what we are familiar with now.

@FrostD since a pet monitor, should we do the syrup at the 40 to 49 range?
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Yes, Shelley is absolutely correct, that is my mistake for not noticing.

For a pet meter, this is a general recommendation:
- 60-68 is high carb wet food food
- 50-59 is high carb wet + syrup
- Below 50 is also high carb wet + syrup, but you really really need to stay on top of re-testing and getting the BG back up

Caveats being if it's an early drop, or a big drop, you may need to intervene sooner or with more carbs. Always err on the side of safety if you're not sure. One thing you have to be careful of though is overfeeding - you don't want to feed so much that they're not hungry. We typically say give them some of the gravy off high carb food and just some nibbles of the food itself. Because if BG continues to drop and they're too full, it becomes a lot harder to manage.

I would actually drop down to 0.1U, that was too far below where we want them with pet meter.
 
@FrostD Bugs is scheduled for her next dose of 0.5u at 6pm today. We did some extra tests this morning. Based off her numbers the last few days and how she seems to drop, are we to change her dose this evening to only 0.1U or see if she drops again before making that change? Her injections are done at 6am and 6pm.

Thanks!
 
@FrostD we did a +3 after Bug's PM dose. Her BG is 58. I followed your prior instructions and we will take some additional tests throughout the night.

Should we do the 0.1 dose in the AM?

Thanks!
 
@FrostD Sorry for the quick, short reply yesterday - just popped in for a sec & I knew you must of missed it & I didn't want anything bad to happen :(

@SKittyMom I'll leave dosing to Melissa, I can't be around enough to follow up these days, but, thanks for fixing your signature to read Pet Monitor :)
 
SKittyMom said:
Morning @FrostD ,

Do we hold this reduced dose for 5 days as well?
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Yes you will hold it until either (a) she drops below 68, or (b) you reach the 5 day mark and re evaluate if she perhaps needs an increase.

If she drops below 68 again, you will start an OTJ trial. She may benefit from a drop dose, but I suspect some of these higher preshots may be slight "bounces" and would like to see how she does without insulin (again, assuming she drops below 68).

@Shelley & Jess no worries!
 
@FrostD That sounds like a plan. I'll reach out if needed over the next 5 days, and if not, I'll reach out after the 5 days for you to check Bug's test numbers. Wish Bug's luck!
 
@FrostD @Suzanne & Darcy

I was looking through old photos and wanted to share how improved Bug's fur is from when we started our journey with you. The top photo is October 2022, and the bottom photo was taken today. The mats and separation are gone as she is now grooming herself daily. Happy Cat Mom!
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@FrostD


I just realized I misread your prior recommendation. Bugs had a 55 BG on the 9th with her reduced dose of 0.1u. We should have started the OTJ trial today. So, I'm going to start one tomorrow. If you think I should hold off, please let me know.
 
@FrostD
Morning! We have completed 4 full days of the OTJ trial on Bugs. I was hoping you could take a look at her spreadsheet to see how she is doing and let me know what you think. Her BG levels are holding pretty steady, mostly in the blue. Do you feel based off her numbers so far, we continue on with the trial? Bugs appears to be doing well, no changes.

Thanks!!
 
I would expect to see lower blues and also greens on her spreadsheet if she’s really in remission. A few of those blues are higher than I would like to see, but you are using a pet meter and not a human one. I know she had that lime on the .1 dose. What I would do is keep on doing exactly what you are doing now for a full two weeks and see if she remains stable where she is now. :) @FrostD what do you think?
 
SKittyMom said:
@FrostD


I just realized I misread your prior recommendation. Bugs had a 55 BG on the 9th with her reduced dose of 0.1u. We should have started the OTJ trial today. So, I'm going to start one tomorrow. If you think I should hold off, please let me know.
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I loved seeing these photos. The fur changes are amazing. Seeing this makes me happy. And I know you have told me before how much better she feels. ❤️
 
SKittyMom said:
@Suzanne & Darcy We are so pleased with her progress. Bugs is her old self again. She got her feisty back.
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Well…. She is a Calico! I have a calico and she’s definitely got some feisty in her. Recently we thought she was just mellowing out with age (she’s 15) but not at all…. Turned out she’s got heart problems and wasn’t feeling well. Now that she’s on the right medications she has all of her old feisty back. She also races through the house and squawks (loud calico meowing.)
 
@FrostD @Suzanne & Darcy

Happy Saturday! We have started day 11 of no insulin for Bugs. Her BG was a bit higher yesterday for a couple of her readings, in the 190's. I wanted to reach out to see if you would check her progress. Her energy level has decreased a bit over the last couple days. Appetite is still good. I'm not sure if what we are seeing with the change in BG is normal along with the minimal behavior change.

Thanks
 
Yes definitely higher than we'd like. I'd restart back on 0.1U and see.

You basicaly have two options when this happens -
1. Switch to a more gentle insulin like lantus/generics. Of course no guarantee it will be more gentle, but it almost always is. It would allow you to bring her down into truly normal numbers and keep her steady without the big swings, and hopefully ease her into remission.
2. If you stick with ProZinc, I think you'll be looking at dosing on an as-needed basis. It's not ideal, but you also can't have her going hypo. You'd essentially have to figure out at what preshot you can safely give a dose, and only shoot when she's above that.
 
@FrostD

Agreed that a more gentle insulin sounds like the better option for us. We won't be able to make the transition immediately though, because we'll need to get an RX from our vet and im not sure if they'll require an exam.

In the interim - how should we proceed with the prozinc? Based on her prior numbers, she was in the 170s when the .1 brought her into the 50s. But we also realize she needs insulin as her numbers inch closer to 200 - so I'm not sure what our NS number should be to start, knowing we will need to monitor and adjust if needed. Any suggestions on where to start with the NS number?
 
It looks like when she was on the .1 dose she went into the 50s which is lower than we want on a pet meter. I am wondering if maybe you need to actually try a drop dose - particularly with those lower preshots where she’s dropped too low. A drop dose is where you take the syringe in your hand and depress the plunger while at the same time keeping the plunger depressed and then once the needle is inserted into the vial you release the plunger. A tiny drop is drawn up into the syringe. I agree about Lantus being a good way to transition her to remission.
 
Suzanne & Darcy said:
There are actually different versions of Lantus. One generic version that is much less expensive than Lantus is called Semglee. It’s all insulin glargine like Lantus. Basaglar is a little less expensive but I think it may be more expensive than Semglee. @Chrispooky12 @Diane Tyler's Mom can you elaborate?
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I paid $98 for a vial of insulin glargine with the goodrx coupon at Meijer not sure if you have one where you live but that was the cheapest place I found it at.
 
@FrostD @Suzanne & Darcy
I'll have Bug's new insulin, Semglee, and the U100 Syringes available to start using On Tuesday February 1st.

1. What starting dosage is recommended based off her current BG levels?
2. Should we even start dosing based off current BG if readings stay at these levels?
3. Will we follow the 2x per day as we were with the Prozinc? (prior to a drop dose using below 170 as a NS number)
4. What will be the NS numbers on the Semglee?
5. When should I transition to the Lantus board?

Thanks!
 
SKittyMom said:
@FrostD @Suzanne & Darcy
I'll have Bug's new insulin, Semglee, and the U100 Syringes available to start using On Tuesday February 1st.

Thanks!
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1. What starting dosage is recommended based off her current BG levels?

If Bugs were my girl, I would start with a drop dose to be safe. If you need to increase to the .1 dose later, based on numbers, you can.

2. Should we even start dosing based off current BG if readings stay at these levels?

3. Will we follow the 2x per day as we were with the Prozinc? (prior to a drop dose using below 170 as a NS number)
Yes. Semglee is dosed every 12 hours just like ProZinc.

4. What will be the NS numbers on the Semglee?

Any number 50 and above is okay to shoot - provided you can monitor and I would say especially with an insulin change that it is very important to monitor her BG. That is why I am recommending the drop dose.

5. When should I transition to the Lantus board?

I guess whenever you want to begin the Semglee you can transition over to the Lantus/Levemir/Biosimilars forum.
I am excited for Bugs!
 
I would post a day or two before you get the new insulin asking for advice about starting dose. I agree with Suzanne, but it's nice to get confirmation - plus then it sticks in their mind to keep an eye out for you as a "new" cat so close to what we hope is remission!
 
@FrostD @Suzanne & Darcy

I just wanted to take a moment and thank you both so much for helping us get Bugs on track. She has improved so much since last Fall. I honestly don't know where we would be if not for the forum and your support. I will check in to let you know how she is doing now that we have joined the Lantus forum. Bugs and I thank you!
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Hi @FrostD @Suzanne & Darcy
I just wanted to share some great news. Bugs had her annual vet appt on 2/27, and her labs came back with her glucose at 138 compared to 524 in March 2022 when she was diagnosed. We are thrilled! We wouldn't have made it this far without you!
 
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