12/11 Webster AMPS=385+2=406+3=388+4=287+5=372+6=330

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Websterthecat

Member Since 2014
Yesterday's condo

I increased Webster's dose to 0.75 this morning. I'm not completely sure if I should have but did so for two reasons. Number one, he hasn't been close to the green for several days and number two, I was questioning his ketone levels last night.

I'm using the Relion Ketone strips and a beige color indicated negative while a very light pink indicates trace. When first dipped, they have always turned a hair pink and then after 15 seconds (instructed length of time to wait) they turn back to beige.

While beige last night, we were questioning if there was a hint of pink with the beige. I'll be stalking him closely today. I just placed my order for the Nova Max Plus ketone meter this morning so I will be patiently awaiting its arrival.

Anyway, I hope that I made the right decision. I wanted to consult with you guys but the site seemed to be down most of the day yesterday.

In addition to the dose increase, I made slight shift to his feeding schedule. After noticing a quick drop off around +3 or so, I shaved off his 5th feeding and added 0.5oz to +1 with hopes to level him off. The new feeding schedule goes:

PS=1.5oz
+1=1.5oz
+2=0.5oz
+3=0.5oz
 
Good call on the dose increase Mike. You hadn't seen any greens on that dose, and had been on it long enough. And especially since there was a concern about ketones. From the protocol:

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
Click to expand...
I noticed you intervene with some 15% after he was dropping. When he's still in higher numbers (above 100), I'd try some lower carb food like Elise mentioned a couple of days ago. Maybe some 8-9% carb if you have it. You could even try his regular LC food to see if that's enough to slow him down.
 
I know Webster and Mikey seem to like the same foods. The Friskies Turkey and Giblets Pate is 8%. Come down with Mikey, Webster. Are you going to ketone test tonight?
 
Wendy&Neko said:
Good call on the dose increase Mike. You hadn't seen any greens on that dose, and had been on it long enough. And especially since there was a concern about ketones. From the protocol:

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
Click to expand...
I noticed you intervene with some 15% after he was dropping. When he's still in higher numbers (above 100), I'd try some lower carb food like Elise mentioned a couple of days ago. Maybe some 8-9% carb if you have it. You could even try his regular LC food to see if that's enough to slow him down.
Click to expand...

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

I believe this is where I am getting confused. I suppose that I am having a difficult time comprehending this statement.

So, lets go back to yesterday for example (12/10). To me, the portion of the statement that reads "before increasing the dose by 0.25" is referring to the previous dose of 0.25u that ended on 12/4 which was increased by 0.25u to 0.50u. There were times (12/4 AM) where he did drop below 200.

I can't wrap my head around exactly what we are looking for here. When and how do we decide to increase his dose? To me, this statement is talking about his previous dose, not his current dose. Do we increase if he meets the criteria for the previous dose and if he's not in the greens?

Sorry, the answer might be obvious but I can be a bit slow sometimes. Maybe an example?

A 8%-9% food is on my shopping list. I should hopefully have some in the next day or so.
 
Marycatmom said:
I know Webster and Mikey seem to like the same foods. The Friskies Turkey and Giblets Pate is 8%. Come down with Mikey, Webster. Are you going to ketone test tonight?
Click to expand...

He likes the Friskies Turkey and Giblets Pate but hes been getting the "Special Diet" Turkey and Giblets which is 4% i believe. I have been thinking about switching him to the regular 8%.

I've been stalking him all day and missed him twice in the box. My ketone meter should be on the way... Hopefully here by Saturday.
 
Hi Mike,
It means the current dose. If Webster is having nadirs below 200--but above 100-- on the current dose, increase the dose by .25 after 6 cycles. But if Webster has only recently begun to have nadirs below 200, hold the dose a few more cycles (8-10 cycles) before increasing by .25. Then, when on the new, increased dose, if Webster has nadirs below 100, hold that new dose for 10 cycles before doing another increase. The idea is gradually to get Webster into the range of a normal (non-diabetic) cat: bg 50-120. You start by addressing the nadir and, ideally, the other numbers will fall into place eventually.

I have added a few editorial clarifications [in brackets] to the section of the protocol you cited above. (Someone please correct me if my interpretation is erroneous!!)

Increasing the dose:
Hold the [current] dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
If your cat is new to numbers under 200, it is recommended to hold the [current] dose for at least 8-10 cycles before increasing.
When [on the new, higher, dose] your cat starts to see nadirs under 100, hold the dose [i.e., the new dose] for at least 10 cycles before increasing.
Click to expand...

Have a good evening,

Ella & Rusty
 
Ella & Rusty & Stu(GA) said:
Hi Mike,
It means the current dose. If Webster is having nadirs below 200--but above 100-- on the current dose, increase the dose by .25 after 6 cycles. But if Webster has only recently begun to have nadirs below 200, hold the dose a few more cycles (8-10 cycles) before increasing by .25. Then, when on the new, increased dose, if Webster has nadirs below 100, hold that new dose for 10 cycles before doing another increase. The idea is gradually to get Webster into the range of a normal (non-diabetic) cat: bg 50-120. You start by addressing the nadir and, ideally, the other numbers will fall into place eventually.

I have added a few editorial clarifications [in brackets] to the section of the protocol you cited above. (Someone please correct me if my interpretation is erroneous!!)

Increasing the dose:
Hold the [current] dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
If your cat is new to numbers under 200, it is recommended to hold the [current] dose for at least 8-10 cycles before increasing.
When [on the new, higher, dose] your cat starts to see nadirs under 100, hold the dose [i.e., the new dose] for at least 10 cycles before increasing.
Click to expand...

Have a good evening,

Ella & Rusty
Click to expand...

Thanks for the clarification Ella.

Now when you say nadirs, what exactly we talking about here?

For example, lets say that you look back on the past 6 cycles and 4 out of 6 cycles have a nadir above 200 while there is a couple that are less than 200. What do you go with? The majority? The average?
 
Hi. The nadir is the lowest point of the cycle. Pretty flat cycle today though. The nadir would be at +4 with the 287.
 
tiffmaxee said:
Hi. The nadir is the lowest point of the cycle. Pretty flat cycle today though. The nadir would be at +4 with the 287.
Click to expand...

Thanks Tiff. I understand that. What I meant was when deciding on whether or not to increase a dose, how do you analyze the Nadirs over 6+ cycles? Say 4 out of 6 had a nadir over 200 while 2 cycles did not. Do you go with the majority? average? depends?
 
Good questios. I don't know the answers though. I let either Marje, Julie, or Wendy advise me when I was at that point.
 
We've had several discussions about this. We look at trends. If the kitty is new to blue numbers, you would want to hold the dose closer to ten cycles before increasing. You did this. When I look at Webster's SS, I see a "little" blue, and not very low blue and alot of high numbers.

Any time a cat is getting into blue numbers for nadirs after a dose increase, I think it is smart to give them a minimum of ten cycles to see if they will settle into the dose.

Webster had 12 cycles and he's spending a lot of time bouncing. I think he could benefit from a 0.25u increase.

It's great that you are testing but you might want to minimize the tests when he is really high and save his ears for when his liver starts to settle down. When he's high, I'd get the +2, mid cycle, and maybe a +10/+11 so you can see where he's headed at his PS.
 
Marje and Gracie said:
We've had several discussions about this. We look at trends. If the kitty is new to blue numbers, you would want to hold the dose closer to ten cycles before increasing. You did this. When I look at Webster's SS, I see a "little" blue, and not very low blue and alot of high numbers.

Any time a cat is getting into blue numbers for nadirs after a dose increase, I think it is smart to give them a minimum of ten cycles to see if they will settle into the dose.

Webster had 12 cycles and he's spending a lot of time bouncing. I think he could benefit from a 0.25u increase.

It's great that you are testing but you might want to minimize the tests when he is really high and save his ears for when his liver starts to settle down. When he's high, I'd get the +2, mid cycle, and maybe a +10/+11 so you can see where he's headed at his PS.
Click to expand...

Thank you Marje. I wasn't sure if these was an exact science to making this determination. I believe that you cleared it up for me.

One of the reasons why I have been testing him often is because I'm trying to figure out an optimal feeding schedule. My thinking is that his fast drop offs could be food related and that feeding him at the right time might help to prevent these drops (and bounces) from happening so fast. So far, I believe that I have been making progress by shifting the heaviest portion of his feeding to the first 2 hours of his cycle. Maybe not? I'm just trying to do what's best for Webster.
 
the testing to determine a feeding schedule makes sense. It also makes sense to feed a larger portion of the food earlier; I think I suggested this some time ago as it was something I had to do with Gracie when she was on lantus.

Just hang in there and stay patient. Determining the best feeding schedule can take time and it doesn't happen overnight.

Good job, Mike!
 
Marje and Gracie said:
the testing to determine a feeding schedule makes sense. It also makes sense to feed a larger portion of the food earlier; I think I suggested this some time ago as it was something I had to do with Gracie when she was on lantus.

Just hang in there and stay patient. Determining the best feeding schedule can take time and it doesn't happen overnight.

Good job, Mike!
Click to expand...

I believe that you are correct.

You guys have offered so much great advice. I can't thank you enough. :smile:
 
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