Cilo's Spreadsheet

• Age/Type: 10 years old, indoor female
• Insulin: Lantus, twice a day (8 AM / 8 PM)
• Testing: Always test before shooting, with a strict 2-hour fast before the pre-shot test.
• Diet: 100% wet food (Fancy Feast Classic Pate) since diagnosis. Prior to this, she was on Royal Canin dry kibble.
• Spreadsheet: LINK

1. Handling Low Pre-Shots: Looking at her spreadsheet LINK, what is the correct protocol when I see these low pre-shot numbers? Should I be skipping or reducing the dose?
2. The Huge Spikes: Are these massive glucose jumps normal after a skipped shot or a low nadir? How much of today's 413 was likely the skipped dose versus the stolen dry kibble?

squeem3 said:

These stickies are helpful:

Sticky - Don't Panic! or How to Handle Low Numbers
Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Sticky - Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers

Numbers do jump due to a fur shot, skipped shot, got into something high carb, stress, etc.

I see that you vary the dose occasionally. Lantus works best if you stick with a dose for at least a week. Changing the dose based on numbers doesn't work. Sticky - What is the Insulin Depot? The only time you would decrease a dose is if the blood glucose level drops to under 90 for SLGS or 50 for TR at any time during the cycle.

You've been on 0.5 for awhile now. Can you do a curve soon? Your cat might need an increase to 0.75 units. Stick with the new dose for a week, do a curve, change dose by no more than 0.25 units, repeat.

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Connie & Moonie said:

Just to add to what squeem said, are you following either TR or SLGS? I couldn't find it in your spreadsheet. I highly recommend that you pick one to follow, because it'll give you the clearest roadmap for what to do - how to increase / reduce your dosage and what to do with low preshots.

I say this as someone who started out not following either method. And I had a very similar experience to yours - a lot of frustration when I'd see high preshots, I'd impulsively change the dose, and then panic when I'd see something too low. And then rinse and repeat with lots of guilt and fear and confusion. I was changing the doses based on random checkpoints - preshots, nadirs, you name it - but all it did was create more violent bounces in Moonie which made her feel sicker. We've been following TR since late May and we've already seen significant improvement in Moonie's numbers - we still bounce when we see blues/greens, but the bounces are now yellows and flatter and quicker to clear.

You can always swap from SLGS to TR and vice versa, but following a method will give you the structure you need to interpret your numbers and systematically adjust doses. Looking at your spreadsheet, you definitely test often enough for TR (at least 4x a day), and if Clio is on wet food only, I'd suggest going with TR if you can. TR has the best / most proven rates of successful regulation and remission because you're able to make changes more quickly and aggressively to get your cat into healing green / blue numbers.

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cilohen said:

Hi! Thank you so much for sharing your experience with Moonie. To be completely honest, I had no idea about TR or SLGS when I started! I was doing the 3-hour tests simply because I thought that was the standard norm for diabetic cats. I am definitely ready to stop flying blind and adopt a structured method.

Since Cilo is 100% on Fancy Feast Classic wet food, and since I am already used to testing frequently, I would love to follow the Tight Regulation (TR) method. It sounds like exactly what we need to flatten out these scary bounces.

How do I officially start? Do I need to add "TR" to my spreadsheet title or forum signature so everyone knows? Also, given that today she hit that 413 bounce after her skipped shot/kibble incident, should I stick at 0.5 units for a few days under TR rules to let the depot rebuild, or should I still look at moving to 0.75 units soon?

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Connie & Moonie said:

Me neither! I wasn't even doing the testing as regularly as you are so you're already so much further ahead than I was.

You can add TR to your spreadsheet and you can also update your forum signature. That way, it's much easier for experienced members to get the information they need at first glance to help you!
Sticky - New? How You Can Help Us Help You!

I'm way too new to give dosing advice. But to make sure this gets on the radar for someone experienced, I would 1) edit your thread to include "?" prefix and 2) Include [Dosing Advice] or something like that in your title. That way, someone experienced knows to come look and respond! Also I'd make sure your google spreadsheet is set to allow anyone with the link view as I think right now, it's restricted

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cilohen said:

Thank you so much for the explanation! That makes perfect sense. To clear up the inconsistent dosing on her spreadsheet: early on, my vet had us on a once-a-day insulin schedule. After doing my own research and reading this forum, I discussed it with her, and we agreed to switch Cilo to the proper twice-a-day schedule starting May 24th.

Because I was so anxious, I actually have been doing 3-hour checks for weeks now! Her nadir consistently seems to hit right around +6 (except for last night). Because I already have all those 3-hour data points on the spreadsheet, do you think that's enough to show she's ready for the 0.75-unit increase, or should I still hold off and run one more formal 12-hour curve?

Also, a quick question for my daily routine moving forward: when we are NOT on a designated curve day, what is the proper everyday testing schedule? Apart from the mandatory AM and PM pre-shot tests, how many mid-cycle spot checks should I be doing on a normal day to keep her safe without over-testing her ears?

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• Hold a wet, cool baby washcloth on the poke site immediately after the test to prevent bruising.
• Put Emla cream on the test sites after each test. It only takes a tiny dab and you can wipe it off before the next test. Emla cream requires a prescription from your vet. Neosporin with has been found to contain a toxin to cats, polymixin and should be avoided.
• You can purchase Ledum 30C homeopathic remedy at any health food store. Dissolve one tablet in a small bottle of pure water and then apply one or two drops to each ear every day. Ledum is great for puncture wounds.

cilohen said:

Understood, thank you so much for all the practical advice! I am going to update my forum signature and spreadsheet title to include "TR" right away. I will also fix the Google Spreadsheet permissions and edit this thread's title as you suggested.

Honestly, hearing that I can safely test less frequently than my current 3-hour routine is a massive relief. I’ve been losing so much sleep lately trying to catch every single window .

If you don't mind me asking, what does your personal daily testing schedule look like while following the TR protocol? At what times/plus-hours do you usually poke Moonie on a normal day? I'd love to see a real-world example of a sustainable schedule!

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Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

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Connie & Moonie said:

I'll respond to just your last question. I'm super paranoid about striking the balance between testing and Moonie's ears. Usually what I do is I test the AMPS / PMPS. If that number is a little too low for comfort (varies for everyone, but for me personally right now, it's 80 or below), I stall for 20 mins without feeding and retest. If that number is flat to rising, I shoot my regular dose since that means the previous dose is out of her system and I'm shooting into a number that should go up with food.

Regardless of what the AMPS/PMPS number is, I try to test at +2 (sometimes I get lazy and let it slip to +3/+4 if the AMPS/PMPS is super high but that's probably not best practice). Based on the +2, I get a sense of how active the cycle will be. If it's dropped >20% and it's a low-ish number (blues or below), I retest at +3 to see where she's at. If the +2 number is up, it's probably not an active cycle and I can go to sleep. Before I go to sleep, if she's at a low blue/green number, I test until she's flat to up. That way, I know that she's not going to drop more while I'm asleep.

It's super helpful that Clio nadirs for you at a regular time because I would guess that helps get the best bang for your buck in terms of testing! Moonie is sort of all the place, and when she breaks cycles, she doesn't nadir... she just gets lower and lower until her preshot is the lowest number. So in those cycles, I end up having to set my alarm to try to test +8-10 as well.

Finally here are some tips in case helpful for maintaining Clio's little ears:

From Marje and Gracie's Testing and Shooting Tips

Ear Care
Since our kitties must endure so many tests, what are some ways to take care of the ears?

• Hold a wet, cool baby washcloth on the poke site immediately after the test to prevent bruising.
• Put Emla cream on the test sites after each test. It only takes a tiny dab and you can wipe it off before the next test. Emla cream requires a prescription from your vet. Neosporin with has been found to contain a toxin to cats, polymixin and should be avoided.
• You can purchase Ledum 30C homeopathic remedy at any health food store. Dissolve one tablet in a small bottle of pure water and then apply one or two drops to each ear every day. Ledum is great for puncture wounds.

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Wendy&Neko said:

You are seeing a lot of bouncing, perfectly normal in a recently diagnosed cats, and some not so recent: Definition here:

See how on the night of the 13th you saw some numbers in the 70's. The following cycle (14th AM) her numbers headed straight up. That is a classic bounce reaction. Numbers then wobbled around, as can happen. Then the night of the 15th she came down again to nice low blues. That is what we call a bounce breaking. Any fur shots can also influence what those cycles look like.

One post I suggest you read is this: New? How You Can Help Us Help You! You'll see a list of information we like to see added to the signature that will quickly answer common questions. Included in that is which dosing method you'd like to follow. Our answers to questions will vary on which dosing method you want to use. It says TR in the spreadsheet, but including that on the signature is also helpful.

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cilohen said:

Thank you so much, the information you just shared is incredibly valuable!

Seeing how you use that +2 test to decide if you can safely go to sleep is a game-changer, and I’m definitely going to try adopting a similar routine tonight so I can finally get some rest.

The ear care tips are an absolute lifesaver, too. I’ve been so worried about Cilo’s little ears hurting, so I am going to look into getting that medicine ASAP.

Thank you again, you’ve given me so much peace of mind today.

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Connie & Moonie said:

Of course! I'm still learning but I'm happy to share what little I do know.

Looking back at what I wrote, the only thing I'd add is that I'd focus more on how fast the +2 is dropping (relative to AMPS/PMPS) rather than the absolute +2 number. Some kitties can throw you a very high PMPS number, drop a lot in +2 but still be at an objectively a high number given the elevated starting point, and then maintain that pace of decline and get you an insanely low number by +6 when the Lantus is really hitting its stride.

If you want an example (of why this is important and what not to do) - check out Moonie's 6/3 pm cycle. I tested PMPS at 225, figured that was pretty darn high so why not wait to test until +3 - and then freaked out when I realized she had gone all the way down to 96 at +3 and then fed her a bunch of high carb wet food in a panic (don't do that either ). If I had tested at +2, I probably would have realized sooner it was an active cycle that night. Or 6/13 evening is another good example - PMPS was 236, but +2 showed 175 which was a decent drop (albeit still a fairly high number), and I think I did the right thing by continuing to test until she flattened out for the evening since she showed me 94 at +5 and that was with me managing her drop with LC wet food the whole time.

On the flip side, if you look at her spreadsheet, whenever she showed me a higher number at +2 than PMPS/AMPS, she never gave me an active cycle and it was definitely safe to go to sleep.

Edit - the only other thing to note (sorry, this has gotten long) is bounce breaks. I noticed Clio is bouncy like my Moonie. As Wendy noted, cats will often react to numbers that are a lot lower than what they're used to (even if that number is objectively high) by dumping a bunch of glycogen into their blood stream. I guess it's their bodies' way of protecting them from hypo and they just need to learn that these lower blood glucose levels are safe. So then you might get a nice green and then see a stinky pinky the next morning. Eventually that bounce will break. For Moonie, it's always in the evening but it's different for every cat. What's helpful to know is that when bounces are breaking, the nadir will typically be at the END of the cycle, such that the PMPS or AMPS will be the lowest number you get rather than the +6 which is the typical nadir. That might influence your sleep / testing timing decisions. So for example, this ended up being useless, but you'll notice last night I woke up at +9 to test Moonie's blood glucose even though her +2 was totally flat (and for the record, I only did the +4 because I was waiting for my laundry... sorry Moonie). That was because I was hoping she'd break her bounce that night and throw me an absurdly low number in the back half of her cycle. Some examples of this happening in Moonie's spreadsheet are 6/8, 6/11, 6/13, 6/15. Sigh she does this a lot.

If you think she might break a bounce that cycle for whatever reason, it could be worth getting a +8-10 or something like that. But I'd say that's probably the only exception I follow to the +2 rule.

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