My original thread https://www.felinediabetes.com/FDMB/threads/new-here.274889/ I am inclined to give Freddie 1.5 units of Insulin in two and a half hours based on his numbers on 1.0 unit the past couple of days. What are your thoughts?
Looking at his spreadsheet, it does appear that he achieved better numbers on the 1.5 unit dose. I would agree that — excepting an unexpectedly low pre shot test — he can get 1.5 units. Ideally, you should keep him on this dose for 7 days so that things can stabilize and we will really know how things are going on that dose. Obviously, if Freddie decides to get up to shenanigans, you may have to adjust things. I hope not.
I was thinking the same thing, however, we may not be seeing quite the full effect of transitioning to LC dry recently and the changing doses the last few days may be making numbers a little wonky too, but Mimi tests enough to catch any lower numbers.
Yes, I would like to ask about the food situation now. What is Freddie eating now? We had talked about a gradual food transition. Where does that stand? Is he completely transitioned to low carb food now? You also said he prefers wet food over dry.
I think it was because of a recommendation from the Feline Diabetes Support Group on Facebook’s team suggested it…. I had got home from work on Thursday and his PMPS was low….
He is eating 90% low carb wet food. 10% of the time he may nibble on the dry which is almost completely transitioned to Dr Elsey’s .
But I saw that Thursday night he got two units. So I was confused to see the 1 unit after that. But anyway never mind. You are monitoring his progress really well! So you want to move forward with the 1.5 unit dose?
Yes, I think so… Do you think 1.25 would be a wiser choice? The reason I gave 2 units was on the advice of his veterinarian.
If you would like to try the 1.25 unit dose first, then that’s fine. Normally, we recommend dose changes be made in .25 increments — although there are circumstances where nadirs are above a certain level and .5 increments are warranted. The only reason why I said that 1.5 would be okay is that he was previously on doses of both 1.5 and also 2 units. The last two days were 1 unit only, but he wasn’t getting good numbers on that — and the dose reduction seemed to be just a temporary reduction that I wanted to ask you about. So, I am okay with the 1.5 dose because you do so much testing. If you are nervous about going back to 1.5 then I am perfectly happy with you trying 1.25 units for 7 days too. It’s really all dependent upon your ability to get tests in and your comfort level. If you are testing, you are in control.
Suzanne, thank you so much for your time and advice! I think I might go ahead with the 1.25 this morning and monitor his progress. Freddie is so easy to test now, when he hears the microwave going when I warm up the rice sock he comes to the counter for his test and treat! The treat is freeze dried chicken.
That is so good to hear. I was thinking that you had the testing thing down pat because your spreadsheet looks so nicely filled in. It’s really a blessing to have a cooperative cat! He likes those treats. . My boy was so easy to test and never gave me a hard time. You are very welcome.
I see you got a nice green and then blue today for Freddie. Very good. I hope it wasn’t scary. That 88 is a safe green number and is in the normal healthy range for a cat. He is still diving down faster than I would like to see in the first two hours of the cycle. Make sure to give a +1 snack and a +2 snack of a heaping teaspoon of wet food. If that doesn’t slow his rate of drop, increase the carbs in the snacks for the very early part of the cycle. Steep drops can definitely trigger bounces. Good night.
@Suzanne & Darcy Do you think it’s too soon to go ahead and increase Freddie’s dose to 1.5 tonight based on his numbers the past few days on 1.25?
How about doing it tomorrow morning? That way he's been on that dose for six cycles. Would that be okay? I know it's so hard to see him in higher numbers. Then you should probably say that you are doing the MPM (modified prozinc method) which allows the more rapid dose adjustments. You can always switch back later on.
I'd hold the dose longer. He's coming off that green and now that fast steep 60% drop 03/13 AM cycle. They tend to bounce harder when the bounce drop is more than 50% from preshot to nadir, and that drop was brutal - over 50% within 2 hours. And, as a reminder, if you're still feeding any amount of dry, SLGS should be followed. Marje & Gracie addresses it in Post#4 & #6 in this thread: https://felinediabetes.com/FDMB/threads/would-like-opinions-on-dosages.254248/
But he dropped into the yellow today - then back up to pink — so I think he already broke the bounce from that brutal drop - of course he may go boing again.
And I definitely feel like a broken record, and I forget who I have asked this of... but you are feeding some snacks in the early part of the cycle... +1, +2, etc.? He drops early and we would like to smooth this out.
I did also want to say that when you are getting blue and green nadirs on a dose, we recommend holding them a bit longer - even when following the more aggressive dosing methods. I just feel sorry for you seeing him in the higher numbers so I think I am almost as anxious as you are to increase.
I gave him 1.25 tonight and was going to give him 1.5 tomorrow morning but now I see @Shelley & Jess feels I should hold it longer.. Freddie really doesn’t eat much dry food at all - it’s Rufus who prefers the dry. It is almost 100% Dr Elsey’s dry right now too.
Yes, he has a total of 3 cans of a mixture of Fancy Feast, Dr Elsey’s canned, or Wellness pate canned.
But at what time (+ what hour?) is he eating this food? I’m only asking because I am trying to figure out how to prevent steep drops. We may have to consider some slightly higher carbs at various points in the cycle (early).
He eats in the morning 9:30 Am and then at midday, and then at 9 :30 pm . He eats a good portion of it but not all of it at once. I leave it out for him to graze.
I just opened him a fourth can as he finished his 3rd can completely and was waiting for more! This is one hour after his pm insulin shot.
That’s good. See on his spreadsheet how he frequently has a huge drop by +2. If you spread his morning or evening meal out a bit by giving him a teaspoon or two at +1 and again at +2 then it could really help prevent steep dives. The steep dives trigger bouncing so that’s why we want to smooth out the cycle. And then we don’t recommend feeding after nadir because it can shorten the duration of the insulin — you can end up with a higher preshot number.
I gave him 1.5 this morning and his AMPS was 19. I gave him some more canned FF - he ate about a tablespoon or two at +1. I just checked his BG at +3 and it was the 14.2. So not as steep of a drop!
Yes the 1.25U should have been held a little longer given the 88, but I wouldn't backtrack right now since I'm seeing this late - just be careful. The increase to 1.5U may be enough to get him close to 50s
Yes he got a snack! His PMPS tonight was in the yellow. I still gave him his 1.5. I will check his BG before I go to bed tonight
Be sure to give the snacks tonight! It seems to be helping. I’m about the yellow preshot as he hasn’t had one in a while. And you are already planning the before bed test so you can handle anything that may arise.
He looked like he was headed into the blue last night since your before bed test was 202. I probably would have given a small low carb snack of wet food at that time before I went to sleep. I hope things will be looking good this morning.
I think I will do a curve on Freddie today. His numbers seem to warrant an increase in dose, I suspect? I would appreciate any thoughts.
I am not so sure. The +4 and +5 time frame is a bit of a mystery, he may very well be dipping into low blue
Melissa (@FrostD) is an absolute whiz at visualizing cycles on a spreadsheet and I see this one too - concerned about the possible blues we're not seeing.
I’m not sure what this signifies being a newbie at this! I thought that because we’re not seeing much blues that the dose should be increased?
Plus 4 looks just fine for today. I’m glad you are doing the curve today so we can all see where he’s going on this dose.
The only blue we’ve documented on this dose is a very high blue and that was at +6 on March 16. I am skeptical that he had a super low blue that day at +4 or +5. At +3 he was mid-yellow. On this dose, Mimi has implemented feeding the suggested snack early in the cycle which have prevented his former early drops. Today his +4 is still yellow. You still will have to wait until March 22 to do an increase, but if things continue along as they are now, I would have no problem with a .25 increase. But you never know what those last few days may bring. He is making some progress. I hope he’s feeling and acting happy.
I agree with Suzanne he could have posiby dropped on the day in ? I would hold the dose longer so your not accidentally missing the right dose. Him wanting to eat & eating well could be he's dropping & he's seeking to eat food to bring his numbers back up sometimes so high that we think increase when that might be saying decrease instead. I would get in as many tests as you can, try to catch a possible low. If you look at Panzer's spreadsheet, I'm an over tester LOL called a test aholic. that's my thoughts but I'm no expert. I would love some more input on Freddie's spreadsheet from other members
Mimi if you want to try to get a +4 one day and a +5 on the other day, it might be helpful. Poor boy os back up high now.
I just got a +4 reading of 115 after a lower than normal AMPS of 326 this morning. I will get a +5 reading tomorrow for sure.
Ok given that you will want to continue to hold, that's a good nadir. Not much wiggle room to increase. Glad my crystal ball is functional!
If you could cut out the dry food then you would be able to get him into a little better numbers. But I know we’ve talked about this before and I know he doesn’t eat very much. Anyway, hopefully he will become less bouncy over time because I hate seeing the higher numbers on his spreadsheet.
Freddie has had 2 yellow AMPS numbers in the last 3 days. I still stuck to the 1.5 insulin and am watching him closely today.
It looks like he’s bouncing from the lower numbers. On 3/30 you documented a blue of 104. His Pmps was pink and we don't have tests until the next morning when he was in the red. On 4/1 he started out in the yellows and went to green during the middle part of the cycle and by evening was in the pink (beginning the bounce) and by morning was in the black. I’m sorry. His body isn’t used to those lower numbers and panics!
Do you feel the 1.5 units is a good dose? I almost reduced it when he had yellow AMPS but held it there. When he is in the black should I increase?
Please, please don't be tempted to increase the dose because of higher pre-shots due to bouncing. We know it's frustrating, but, all we can do is be patient, wait it out and give Freddie a chance to clear it. And, don't look at just that one number, look at the big picture, look at how the cycles flow, he drops at least 50% to nadir from those higher preshots - that's awesome movement in the cycle! Some cats stay really high and flat for days through a bounce.
I don’t think you have much room to increase- the way things stand right now anyway- because you have seen green and lower blues on this dose. Those higher preshots are hard to see. But I don’t think it’s necessarily safe to shoot an increased dose on those days. You don’t know when he’s going to break his bounce - especially since Freddie doesn’t seem to stay up there very long. It’s possible he’s also dropping lower at night, resulting in the high morning preshot numbers. If things start to settle a bit, you may have some wiggle room to tweak the dose, but right now it seems to be working fairly well for him.
What do y’all think? I’m checking back in on Freddie and for the last 7 days he hasn’t seen lower blues or any greens. I’m thinking that he could possibly be safe with an increase tomorrow morning if this trend continues. @FrostD @Shelley & Jess
Oop, just missed ya! At first glance he does appear to be sneaking up, but, wonder how often he's dropping lower at night cuz he's got such good movement during the day. You caught that 144 from a high red AM preshot and he zoomed back to high red at PMPS that cycle. And, wondering what happened in the PM cycles before you got those yellow AMPS's - late bounce break or maybe going too low? Can you do a curve today or a few extra tests & would love to see more PM tests if/when possible.
I won’t be able to do much of a curve today as I am headed over to my sister’s this afternoon. I will try to get a couple tests in before I leave.
Sorry. Very busy Easter Sunday morning! I’m happy you did the 1.75 increase this morning and I see you have gotten a lower yellow
Freddie had a yellow AMPS this morning and I reduced his dose to 1.5 instead of 1.75. I am thinking maybe I should have reduced it even more?
I think you did just fine. He had a lovely nadir today. Perhaps this lower AMPS is a sign of progress.
Hi. I hope next time you get a preshot of about 266 you can get some mid-cycle tests so we can see if the full dose of 1.75 is okay at that dose. I hope things are going all right
Hi. Just looking at his SS. I see some good blues. Sorry about the high preshots though. Write us when you can and let us know how he is doing.
I just did his PMPS half an hour earlier and it was 7.3 (blue) so I am skipping his Insulin tonight. I am getting ready for a family get together later this week so wanted to change his dose time slightly. Freddie is doing fine by the way. He still has quite the appetite and is his old self!
I would not have skipped his insulin entirely but would have given a token dose - like a half dose - as long as I could do my usual monitoring. You will have another opportunity to see how he does when he has a blue preshot. I thought maybe last night you were saying that you were not able to check his BG. I looked at his spreadsheet and was worried about how high he would go by the morning with no insulin. Oh well, today is another day
I've been peeking in on you and Freddie, don't like seeing more and more blacks showing up . Black (almost) always means bouncing, but it's a bit of a mystery what he might be bouncing from. It could be from fast drops, we've seen those in the past - he could still be sometimes diving fast & early in the cycle and on his way back up by the time you do your AM+5 or +6, but the bigger concern with limited testing is you're not catching if he's going too low somewhere. Most kittys go lower at night and there's alot of data missing there. You shoot late, does a before bed test every night work to get a PM+2 or later? Or, what time do you get up in the morning? Could you grab a first thing in the morning test, even if it makes it a PM+8, +9 or +10, might help us see what's going on. We've had kittys go from red or black at PS, tree green or lime mid cycle and back to red or black by the next PS, I'm concerned you might be missing something like this. If he's been dropping below 90 (5mmol) somewhere he would have earned a reduction following SLGS. (You don't test enough to follow MPM like your spreadsheet indicates, along with the bit of dry it looks like you're still feeding - it really does make a difference). I know test strips are stupid expensive in Canada (been there, done that). I just want to make sure Freddie is staying safe and the only way to know is with a bit of extra testing if possible.
Thank you for looking in on us! I could try to get a before bed test - it would be +2 . I don’t know if you noticed but I had to skip his dose twice in late April. I will also be leaving the house at 7:00 am on Wednesday so will, after a BG test, be administering his Insulin early if the test warrants it.
There’s no BG test recorded for the two evenings that you skipped in late April. What were the preshot test numbers that caused you to skip? How early will the shot be on Wednesday? How many minutes?
As per the notes, I skipped because I had to go out of town so no BG preshot numbers. The shot will be 2.5 to 3 hours early on Wednesday.
Oh, I'm sorry! I missed that in the notes. I was looking at your spreadsheet on my phone and I didn't see that.
And wow! 2.5 to three hours is really too early to shoot. I don't think I would do it -- and you don't have time to make much of an adjustment. Insulin shots generally should not be adjusted by more than 30 minutes per day (either 15 minutes at either shot -- or 30 minutes at a time.) It could really mess you up for the PM shot. But I know you will be careful with Freddie and take the BG into account.
So my OneTouch Verio Reflect meter is not reading Freddie’s blood this morning so I had to give him Insulin blind. The meter says Apply blood and I do and it does not give a reading.. I tried 3 strips and the message doesn’t change it just reads apply blood. I called customer service and as soon as they found out I was using it on a cat they would not troubleshoot or send a replacement. Very frustrating…. I guess I will pick up another meter today. Just wanted to vent.
Hmm I wonder if it is the battery. I’m not getting any reading at all but can still view the logs and summary. How long before the batteries got low on yours @Shelley & Jess ? Mine is 6 months old.
Hmmm, can't remember now, but do remember the ones that came with it barely lasted a month so I bought a bulk pack of batteries and remember replacing numerous times.
Just checking in as it’s been awhile. Freddie has begun to exhibit neuropathy in his back legs, I would say over the last week or two. I live in a 1 bedroom apartment but am currently house sitting at my sister’s house so really notice it with him on the stairs here. I have ordered Zobaline via Amazon and it should get here in a week or so. What is the dosage for Zobaline?
I'm sorry to hear that Freddy is having problems with his back legs. You can give 1 or 2 tablets of the Zobaline per day, depending on how severe the neuropathy is.
Based on the fact that Freddie has neuropathy now and he is rarely getting in the greens mid cycle, do you feel I should increase his dose by 0.25?
Yes. I was looking at his spreadsheet and I think you should try an increase. He’s still eating the same foods? And same feeding schedule? I hate seeing those reds and blacks on his spreadsheet.
If he doesn’t get into green, then let’s look at increasing his dose after 7 days. Holding doses for too long can make it more difficult to get into better numbers.
He’s been at 2.00 for quite a while now, so I take it I should increase now? I’ll give him 2.25 this morning. He’s due for his am shot in 10 minutes. Yes he’s still eating FF and Dr Elsey’s cans as well as dry Dr Elsey’s. But mostly the canned.
So Freddie seems to be responding well to his increase. In fact I’ve had to shoot lower doses due to low PMPS on 3 evening occasions including tonight and one morning low AMPS. I wonder what this means going forward? I forgot to add that I have been giving Freddie 5000 mcg of B12 every night for a week now. His Zobaline has not yet arrived.
Is there any change in his neuropathy? You are doing well. Is there any way you can test at night? I've been studying his spreadsheet and there are just so many gaps in the p.m. cycles, it's very hard to see what is happening. I'm happy that we are seeing some green from time to time.
Yes, his neuropathy seems to be improving. I will try to get a test at night, probably at +2 or +3 as his pm shot is at 9:30pm.
Yes, I’m happy that he seems more comfortable. His Zobaline arrived today but I think I will continue with the nightly 5000mcg of B12 until I run out, then start the Zobaline.
So Freddie had a green Pmps, so I skipped his Insulin tonight. First time in ages I have skipped a dose! Fingers crossed he doesn’t go too high tomorrow morning!
Sadly, I see he did go higher. I think you should have given a reduced dose. I think it’s good he had a green PMPS though.