? 03/17 Raven AMPS 245 +2-234 +5-134 +7-101 PMPS 169 +1-247

@Bandit's Mom -- thank you so much for your responses to my post yesterday. Super helpful! I will take a look at the probiotics dosage. On the TR protocol question - I've been encouraged to switch to TR given how often I do readings. However, I'm gone all day 3 days a week, so on those days measures are scarce. In addition, I've now heard several times that if you feed any dry food at all you can't do TR -- is that accurate? I feed small amounts of Dr Elsey Clean Protein Chicken (just a couple of table spoons) sometimes to supplement / if Raven doesn't have a good appetite and only licks at his pates. So if that's the case, I'll have to stick with SSGS.

Now for today:

I'm on 5th cycle of Raven's lowered dose of 1.75 (from 2us) and his numbers have been lower - in the blues and yellows -- with one of his lowest (non-crisis) nadirs of 101 at +7.

I expected them to go back to the pinks and yellows (the range he was on on 1.75 us before I increased to 2us). I suspect this might be tied to food. He is eating but not as much as he was previously. His stools are still very soft.

I also realized I had his timed feeder on the wrong setting overnight (pm instead of am) -- so he didn't get his 1am and 4am snacks -- last meal yesterday was at 10pm and breakfast at 6:30am. Could this be part of the reason? I've also switched to a different treat (from FF purely chicken treats to Rabbit Keto treats post BG readings).

@Margaret (and Pearl) -- tagging you hear just as FYI - please tell me if this is getting too annoying. I called Crunchies yesterday btw and they do carry the RAWZ pate I ordered online (as well as some other frozen raw options I might check out). So I will try to get it there in the future if it works out. Much prefer supporting local businesses. Thanks for the tip.

https://www.felinediabetes.com/FDMB/threads/03-16-raven-amps-249-pmps-303.275358/

 

Yes, dry food would mean you follow SLGS. TR requires the cat to be on a low carb canned diet. Once you get comfortable with lower numbers you could look at a lower reduction point for SLGS. Some folks who test quite a bit look at 80 or 70 to take reductions. That way they can hold a dose at which a cat spends time at the higher end of normal numbers.

Can you give him some food? Will he eat? Looks like he might have a later nadir like he did on 3/14. Hope you are ready to shoot blue tonight

I'm off to bed (since it's 1 am for me), but if you need any help at PMPS, tag any of these people:
@tiffmaxee
@Bron and Sheba (GA)
@Angela & Cleo
@Chris & China (GA)

 

Thanks very much and good night!

 

Hi @SophieFRA! How is the Jarrow going? You can start with the 1/2 capsule twice daily that Bhooma mentioned. The way the stop diarrhea protocol works is that you have to keep increasing the probiotic every few days until you see progress. Have you noticed any progress yet and how much have you been giving now?

I see you got some Rawz. Will he eat it and does he like it? What flavor did you pick?

 

I haven't received the Rawz yet. I ordered it from Austin but it should get here by Monday I think. I went with Rabbit. I've seen a slight improvement in stool -- from liquid puddle to slushy consistency. I'm not sure if it is the probiotic since he is always going through waves. this morning I gave half a capsule and will give other half this evening. yesterday I gave two full ones. Ok I will try that.

 

Hi all, Raven's PMPS shot is unusually low (169) and he does not have much of an appetite. I just gave him some mirtazapine. The question is should I stall, or shoot a reduced dose? When I gave the normal does on Tuesday at 149 PMPS Raven's BG dropped too low too fast (71 nadir stopped by high carb). I don't want to go through that again tonight -- especially in combination with poor appetite. He also just had totally liquid diarrhea outside of the box again. Do you have advice? Thank you!

@tiffmaxee
@Bron and Sheba (GA)
@Angela & Cleo
@Chris & China (GA)
@Margaret (and Pearl)

 

PS: I did just get him to eat a different food I found (Weruva slide and serve duck and chicken) -- absolutely not limited ingredient but I'm hoping that the majority duck will agree with him better. However he of course immediately detected the portion that had the Jarrow probiotic mixed in and is not eating it.

 

PMPS: He's now at 186 after some food and 30 mins later. So I'm getting into a more comfortable range but would still appreciate input on whether to give full 1.75us or reduce.

ank you!
@@tiffmaxee
@@Bron and Sheba (GA)
@@Angela & Cleo
@@Chris & China (GA)
@@Margaret (and Pearl)

 

Update: I gave him 1.5us (vs 1.75) about 45 mins late. He is eating his dry food rather enthusiastically. So that makes me feel better...

 

Sorry, I'm just seeing your posts now. How long have you stalled? How long from when you fed until the test with the 186? What did you feed? Do you think Raven will eat more before onset (usually +2 hours after the shot)? Sorry for all the questions, just trying to get a full picture

 

I stalled 45 mins. About 20 mins from when I tested at 186. I will try to give him more food. I definitely think he'd be up for dry food and treats if I tried And hopefully the mirtazapine will kick in so maybe he'll even go for more wet food.

 

Just to recap...and let me know if correct:
+12 = 169 and food?
+12.5 = 186 ate dry food?
+12.75 you gave a reduced dose of 1.5

Lets see where he is at +1 before giving another snack. Do you think you'll be able to test @+1?

 

Yes definitely. I'm home.

 

+1 is 247 - just gave him a treat after but not feeding anything else right now.

 

I was gone all day and apologize for not seeing this until now. Giving 1.5 will not very likely affect the first half of the cycle. You could have shot 1.75. If you wanted a BCS dose I would have given .5 or 1.0. He’s already going up which would have happened with 1.75 too. When you stall you don’t want to feed so you can see if the bg is rising by itself and not food influenced. The bg was not so low that it mattered this time but something to remember especially if the bg is under 150.

 

When you stall because the Preshot is lower than normal, you don’t feed. The reason is to see if the Preshot is rising on its own. If you feed, the BG is good influenced. So next time when you stall, don’t feed and test the BG 20 minutes later to see if the Preshot is rising.

 

Ok got it.

 

Sorry I totally missed your comment earlier. So if I understand correctly if he‘s under 150 and not going up w/o food in the future I should consider givibg a lowered dose of 0.5 or 1u? Thanks so much!

 

From the dosing sticky:


Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.
• Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
  • a.) give nothing
  • b.) give a token dose (10-25% of the usual dose)
  • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

 

Once you have data most lower the no shot/reduced dose numbers.

 

Once you have data from the sticky on dosing:


Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Levemir, and Biosimilars users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:

• Do you need to stay on schedule? Then skip the shot.
• Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
• Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.

If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.