05/16-17 Dude AMPS 570, +3 424, +7 177, PMPS 191, +2.5 330, +8.5 HI

He did eat 6g od Purina DM last night & 16g yesterday afternoon (Dr Elsey's cleanprotein now, trying to transition to FF Pate but he just won't eat it), the remainder of his food was FF Pate syringe-fed. He's eaten DM before without the high BG level, but he was on 0.5 units.

I wonder if trying to get 0.25 units was a big mistake, he's gone downhill since. I think too much variation in manufacturing/user exists with the result that little/no insulin is given at times. If you're on a good regimen of little/no carbs the risk of no insulin is okay, otherwise it doesn't seem so.

 

With SLGS once a reduction is earned you reduce if under 90 and hold that dose for 7 days. If see you going back and forth between.25 and .50 on your spreadsheet. Syringe markings do vary.

If you want to be more accurate digital calipers really help. Have you seen the video?
When can you do a curve and get a few nadir checks at night?
https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/#post-862835

 

Here is your last post, to help with following: 05/15 Dude AMPS 306, +4 210, +7 189, PMPS 425, +4 failure
I am not sure how to advise you, I am not very familiar with SLGS, but it seems like you took too many reductions Did you read the sticky about dosing?
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
With SLGS, you reduce if your cat goes below 90. If not, hold the dose for a week:

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

 

I was trying to follow that but advised to reduce the dose. Well-intentioned advice perhaps, but absolutely wrong. I was stupid to take it. His neuropathy is back & he's reluctant to come out. I've lost all of the progress & hopefully this doesn't lead to cascading sequence of events.

You just can't miro-dose a consistent amount, even using calipers, at least with the Uticare syringes I'm using. I'd advise NO ONE to do this unless you are on a well-established low-carb diet where you can give too little or no insulin.

 

I used calipers successfully. I ignored the syringe markings.

 

If you were advised to decrease, then you were right to do it.
I use callipers and a chart with very clear markings, I will share it.
Edit: the chart is not for your brand of syringes, so that would not work, but there might be one, you should try to search the forum for callipers and fine-dosing.

 

Since you are feeding dry food, you have to follow SLGS for dosing. That means sticking with 0.25 units. This is for the safety of your cat. Changing dosing any faster means more testing cycles than you have done, because we need to catch lower number.

Whenever I see a high number like that 570, my first question is "what caused it?". I look back at the cycle before hand, and my answer to the question is "no clue, there was no testing after PMPS". I suspect that 570 was a bounce.

We dose based on how low the dose is taking the cat, not the preshot numbers or bounce numbers. I know how hard it is not to respond to high preshots, but with Lantus we have to learn to be patient.

I too used calipers with Neko - she was on an all low carb raw diet. She was hardly on a low dose all the time, she got up to 8.75 units of insulin. She was sensitive to small changes in doses, as I found out when I started using calipers and her numbers got more even. I was using the BD syringes which had horribly inconsistent markings. This post also mentions the Uticare syringes: Dosing with calipers

 

The last 3 readings are 425, 570, & 424 after going down to 0.25 units. He's not well, this was a huge mistake.

The human eye probably (maybe almost certainly in practice) lacks the visual acuity to measure 0.25 units. I'll do the math & confirm.

 

Here are some of the factors affecting dosing:
visual acuity, light, distance, viewing angle, differences from standard/"normal" vision, "just noticeable difference", manufacturing tolerance.

Just by looking at some of this from a high level, it's apparent that dosing at 0.25 units will be problematic. I'll write it all up for discussion in another post.

 

Down to 177 at +7.

I want to be clear that I'm not angry about the advice. I asked for it. I took it. I'm angry at myself because I don't have the knowledge. I appreciate everyone being concerned about Dude & wanting to help. Board members put a lot into helping these cats, thank you.

 

Mike, Dude was doing fine on 0.25 IU until he started to eat dry food.
It is encouraged that you try and wean him off the syringe, and I understand he prefers kibbles over wet food. Most of them do. [At this point I'm certain most of the kibbles are infused with cat crack or something that makes the cats addicted.] But as other members stated, in the US there are much better options available, such as Dr Elsey's - which you stated you already ordered/trying out with him hopefully by the time I'm posting this.

Purina DM is the devil. I'm not sure whether I posted this, I remember I wanted to and typed it up, but perhaps didn't send the comment - if I did, apologies for the repetition.
Mister's BG skyrockets on Purina DM. Let alone that, it's incredibly addictive - my other two cats wouldn't touch anything else anymore, hardly even their favourite wet food, which was never an issue prior to changing their cheap kibble to ProPlan. "Veterinary diets" are marketing campaigns and the practices that push those receive commissions from the big corporates [Purina, Hill's, Royal Canin] - my vet confirmed this. Doubt it would be any different in the US.

I have to agree with Wendy. In my opinion Dude is
a) either dropping too low in the PM cycle on 0.5 IU and bounces back high by the AM, or
b) he's giving you horrendously high numbers due to the dry food.
Or perhaps both of the above.

When you fed him only ±5g dry prior to nadir/+6 he was still OK, but feeding him that junk and in higher amounts right before pre-shots is screwing with him.

LOL come on, man! We all wrong then, yeah?
Did you do the math? I hope you did, and it was on the callipers...
They are easy to use, once you have a starting point carefully measured. This is the only tricky part that takes time. You have to have a reference point, if you're lucky it ends in an even number e.g.
1 IU = 1,40 mm
You double-triple-quarduple check that value on many syringes randomly, at random places along them [not only on the top 1 IU] to ensure validity and reliability. Once you have a starting point established, it's simple math from then on and the syringe markings can be completely ignored.


Dude was doing fantastic. Don't take that away from him with the dry food for your and his temporary comfort/convenience and with excuses of lack of ability to measure certain doses, because you're doing more damage to him on the long run.
You're provided with all the help and info now, that you were in so much need of at the beginning. Use it then. For the sake of your cat.



Edit: Should you change syringes to BD micro-fine, there is a printed dosing chart for that specific brand that allows you to dose even as little as 0.1 IU. That chart was made by the Germans, so you can be sure it's precise I'm sure it's linked on FDMB somewhere, but if not, I'll copy it for you from my profile on the German forum.

 

Yeah, so he dropped 400 points in 7 hours on 0.5 IU.
AMPS 570 --> AM+7 177

Which means, last night, when you shot that 425 with 0.5 IU he likely had dropped to a dangerously low 25 by PM+7 [which he bounced from]...

...that is, if he was eating as much at the PM cycle as he was throughout the AM. Likely dropped even lower, if he wasn't.

You're literally playing with his life at this point...

 

Neurospicy pattern recognition. But I did say likely, and not definitely Data would help, 100%.

 

Fortunately, that's not how it works. Typically, the lower you shoot, the flatter the cycle. Though anything over 300 is just plain too high and very unpredictable. Take a look at some of the other posts on this forum. You see people shooting lower numbers and getting flatter cycles. I loved shooting the 80's, that was Neko's magic zone. She'd move no more than 10 points the entire cycle - unless she bounced.

Don is right though, without data we are only guessing.

I always loaded the syringe at the same spot, so same lighting, same background colour - I found white/light background made it easier. My arms didn't change, so always had the same distance and viewing angle. I used a magnifying glass and a pair of cheap cheater glasses to get as much magnification as I could. Some people get craft glasses that both have head lamps and a magnifier. The bonus with calipers is that I could be away from the house at shot time, and hubby could give the shot, to my specifications.

 

It can though unfortunately, until the cat is regulated and/or until they're in a set routine re: feeding for example. Especially tricky at the beginning and when they have underlying health issues, all which is applicable to Dude.

Yes, when their cats are regulated and in an established routine, with most of their underlying health issues tamed [as much as they can be tamed, anyway]. Nothing's better than seeing consistent greenery, instead of a sheet that lights up like a Christmas tree.

And that exactly was the case with Dude in my opinion.

This killed me! Imagine waking up with T-Rex arms one morning

To add to dosing technique: Personally I'm so paranoid [and blind] that I cross-examine the drawn out dose every time:
1) I measure it at eye level
2) check against dark background, held at eye level [calliper against the visible thin silver perforation on the top of the syringe]
3) check against my back-lit LED mirror, held at eye level [no visible perforation line]
4) check against my phone's background/ layed flat on top of the back-lit surface [no visible perforation line]
This may sound extensive, but it quickly becomes a habit and can be done in less than 5 minutes.

 

He's at PMPS 191. From what I'm reading & my experience with variability in creating a 0.25 dose, I might've given him none or very little. The rebound effect probably caused hyperglycemia which then led to glucose in his urine, leading to excessive drinking (which which was noticeable) & increased urine output (the number of times he "went" increased 30%). From what I'm reading the quick rise in BG level from this would lead to lethargy & weakness (which I saw occur) or dehydration or electrolyte imbalance, from drinking water, both of which would also lead to lethargy & weakness. The risk of little/no insulin isn't as high of a risk as too much, but it's definitely a concern after this. It's frightening to see the change & wonder if you've just killed your cat. Very confusing & I'm worried about changing his dose any more.

 

At +2.5 from PMPS he's at 330. A bit surprised. He ate a bunch of Dr. Elsey's cleanprotein tonight. Did I get too cute with trying to move the dosage below 0.5 & gave nothing? I've got to leave it at just 0.5 from now on.

 

He did a really big drop from +4 to +7 today, then a long stretch in blue. Either one would be enough to cause a bounce. It's not the dosing that's the issue, it's that he saw numbers he's not used to and/or dropped fast.

I would encourage you to try to stick with a dose for at least 7 days. The depot of your current dose would not even be full after 4 cycles at this dose that you have done. So we don't know what this dose can do.

 

Also, remember, Lantus' onset [when it starts to "kick in"] is usually around +2. He could've bounced, but the number also could be higher due to eating a fair bit/more than he's used to at PMPS. Or both, of course.

 

At +8.5 from PMPS he's HI. I must've gotten no insulin in him. Not sure what to do here.

 

This is just worse. Is it the food? Consolidation of what he ate after AMPS (he had 3g Purina DM 2 hours before & another 3g 1 hour before). I've got him eating kibble on his own (with a lot of appetite stimulants) . He won't touch wet food on his own, the FF Salmon was syringe-fed.

 

You keep to the protocol and [as suggested before] you shoot the same dose. We all have given fur shots before.

Also: Don't feed him dry food Just because it's high protein and is okay [but not good!] for diabetes, it doesn't mean it's beneficial for his urinary tract, GI tract, kidneys and pancreas. It may have caused him internal discomfort* and that's why his BG is running havoc.

*this could be anything from a benign constipation issue, to something more serious e.g. a pancreatic flare-up.

 

I posted what he ate, just a tiny bit of Purina DM. Back in April at a higher dose he ate a lot of DM & was okay.

 

Mix some wet in his kibbles. Gradually add more over time, until he's weaned off the dry. May take some time, but slowly [and sneaky] does it.
There's a sticky post on how to transition them from dry to wet food only. I'll see if I can find it to link it for you, but I'm on my phone. Someone may be quicker to help you with this.

 

He won't eat wet food on his own, I keep trying but I can't let him go long without food. I'm struggling to syringe-feed him due to my back & he's pushing back. Dry food is a temp solution I hope.

 

You mean those times when you couldn't test him/have no data of, and he was constantly miserable? He didn't let you test him, because he was constantly feeling awful, Mike. Either due to bouncing from too much insulin, or... well, his BG running havoc from the dry food... and the bouncing.

I don't know what else can I tell you. I'm trying to help you, but there's only so much I can say, and only so many times.

If you think it's not the food, then he may have a flare up. I don't know, man.

 

Well, don't quit saying stuff. I'll eventually get it. Headed to the vet to see what he says.

 

I wasn't insinuating that you don't get it, apologies if it came across that way.
I know how hard it is at the beginning, trying to reason with the hows and whys, trying to see a pattern, and how frustrating it is not being able to.
Your poor boy has so much going on at the same time, there are a lot of possibilities why things can/do go sideways.

Keep us in the loop re: the vet visit.
But I'm warning you, I will clock off if they recommend you putting him back on a horrendously huge dose without good reason, and you end up following it! Yes, I'm threatening you