5/7 Tiggy AMPS 274 - non compliance - dont duplicate!!!

[Wendy&Tiggy(GA)]

Previous condo

I am being naughty. I am not obeying the protocol right now and am looking forward to what people have to say about it. Since the last year I have pretty much been obeying the protocol but Tiggy has been slowly increasing his dose. He looks to me to have a fairly unusual pattern and I want to experiment with something else. i.e.

1. Gets an increase
2. gets nice greens one day, followed by a bounce to pink or high yellow the next
3. repeat of greens/blues to pink bounces
4. gradually nice greens go away and earns another increase - now he is at 8.

I am wondering if he is just spending too much time in the bounce that its causing the toxicity which is why he slowly creeps up. So I didnt wait this time and increased him 1/2IU after three days since I wasnt seeing as much blues or greens as I would like.

So my plan - this is non compliant to the TR protocol. I am also basing this on the fact that currently I reduce under 40 or under 50 with a stall. But isnt that number a little dependent on the meter and its 20% variance? so I am going to alter my reduction thresholds. I am going to do this for a week or so see how it goes.

1. I will keep increasing 1/2IU every 3 days unless he is spending most of his time (2/3 of the time) in blue green, or he goes very low as per below.
2. I wont reduce unless he goes 20% under 40 ie 35. (20% under 40 is actually 33 but that scares me)
3. I wont stall unless he is under 35 - before my stall number was 50. But I will get a 30 min pretest before each pre shot just in case he is dropping and if he is 35 and dropping, then i will stall.
4. I will be testing a LOT. and lots of high carb/syrup at the ready.

Thoughts? If this doesnt work, I am going to go with the R which I have on order.

Wendy

 

[PeterDevonMocha]

Hi guys .. I don't have any advice about your new plan, but hopefully others with better knowledge can help you figure out the best way to work tiggys numbers .. Sometimes it is all trial and error .. have a great day!

 

[Sienne and Gabby (GA)]

I'm not sure what you mean by "stalling" the dose reduction. Could you clarify?

My knee jerk is that you might want to try what the German Lantus group does. They do not reduce the dose until the kitty's numbers fall between 40 - 50 three times or below 40 once. They then take a full 0.25u reduction.

The aspect of what you've outlined that I'm not comfortable with is factoring in meter variance so you're not reducing when numbers drop below 40. You have no margin of error if you're waiting for a 35. Granted, it's not much of a difference between a 35 and a 40 but you've got to remember that meter variance cuts both ways. A 35 could also be 28 (i.e., 20% less than 35).

I do think that once you've been at this for a while, you need to take ECID to heart and make adjustments that make sense for your cat.

 

[Dale 'n' Chip]

You are not that far off the reservation, except for perhaps one item:

3. I wont stall unless he is under 35 - before my stall number was 50. But I will get a 30 min pretest before each pre shot just in case he is dropping and if he is 35 and dropping, then i will stall.

That one worries me with Lantus, any time. But especially with bigger doses. There may be potential for inadvertently sending him lower than you can control?

Before you get to the point of shooting that low (even as an advanced user) I'd want to see what Libby and Jill think about it. They are experienced with some aggressive techniques they only bring out for the most advanced caregivers for obvious reasons.

I believe stalling (for short periods?) is a useful technique. I might shoot Levemir as low as a confirmed 45, but likely not Lantus.

 

[Wendy&Tiggy(GA)]

Sorry , I meant that I normally stall and dont give him the shot if he is under 50. I wait and test every 30minutes to see which way he is going and shoot when he goes over 50.

Now I am thinking instead I wont stall unless he is under 35. But I will also do a check 30 minutes before his shot is due in case he is dropping...

 

[Ann & Tess GA]

I've shot under 50 on occasion, but only when Tess is coming up or is surfing. Why do you want to go as low as 35? Looking at Tiggy's SS you really haven't needed to stall often, I only saw one stall w/ the 47 preshot this year. Maybe take it in steps, go to 45 for your stall number and see if that helps, 35 is a big step down.

Everyone has to modify when we get to be old timers, we've learned what works for our cats. I do the 3 under 50 or 1 under 40 for Tess, but just shave the dose, not a full.25u. Tess doesn't hold full reductions, besides .25u would take her OTJ and she definitely still needs her juice. :roll:

 

[TheBowHuntress]

Good luck in your venture Wendy! Of course I have no advice, but am real curious as to however your plan turns out
I'll keep my eye on Tiggy's condo :mrgreen:

 

[Marje and Gracie]

I'd like to throw my two cents worth in, FWIW. Just something else to consider.

Looking at his SS:
4/7: dose is 6.75u with nadirs in the 50s
4/8: no mid cycle tests to see if he cleared the bounce
4/10: increased the dose and he went back into the 50s that cycle which was probably not attributable to the dose increase
4/11: no mid cycle tests
4/15: dose increase for four cycles before you went on vacation but no nighttime tests to see what he was doing
4/17-4/21: dose reduction for DPS
4/22: dose increase without knowing what he had been doing at 6.75u which often looks like a good dose for him; I have to wonder if he went lower during the DPS time because of the bounce
4/25: another dose increase after only five cycles, one of which there was no midcycle testing
4/26: in the 40s
4/27: no spot checks
4/28-4/30: missing some spot checks at night
4/30: furshot
4/30 dose increase but missing spot checks in several cycles
5/7: dose increase

I think there are alot of furshots (perhaps the method you use needs to be changed?) which affect the depot. But I also think you are not giving time for him to recover from the fur shots and you are raising the dose when his nadirs are in the 50s. Tiggy is a bouncy cat (like others I know ;-) ) IMHO, you should be getting a spot check every single cycle...it doesn't matter how high he is. Sienne and I both have seen cats (our own) that were 300 at AMPS, 40 at mid cycle, and 300 at PMPS; without the spot checks, we would have assumed they were high all day. I also think when you increase the dose, give him time to adjust. A great example Jill gave me was to think of the action of lantus like steering a cruise ship. You can turn the wheel to change course but it doesn't happen immediately....it takes time and patience. Some doses you've held ten cycles, others you've increased too quickly without the spot checks to base the increase on.

Here's some great advice from Libby:

I remember being frustrated that Lucy was pink at AMPS almost every single day, even though she went green at night. Jojo told me not to worry about the pink, she was spending more and more time in green so the little bit of pink didn't matter. She finally got to the point where she was pink for just a few hours every morning. One day she just completely stopped bouncing.

So yes, I would dose to the nadir you want and wait for the numbers to fall into place. If you want nadirs in the 60s (which seems like a good goal), then adjust the dose until the nadirs fall into the 60s. Then STOP. She will eventually start to flatten out. That might take a long time. Once she flattens out, it might be higher than 60s, so you would adjust the dose again to put her back where you want her. If she drops lower than 60s, reduce the dose again to keep her nadirs in that range.

Spend some time studying Mocha's spreadsheet. Devon was good at holding doses once they started doing good things. At one point she held the 3u dose for basically a whole month, with numbers that looked a lot like Gracie's do now. Some other doses on the way down the dosing scale were held about that long because the nadirs were good. Also look at Tuffy - she was on 3.5u for almost 3 months. It took 2 months for her to start to flatten out, but then she headed down the dosing scale.

I added the bold because that statement was :idea: for me.

I would not change your stall number but I would do as Sienne suggests and not give the reduction until Tiggy has been between 40-50 three times on separate days or below 40 once. Gracie is on levemir and so she onsets late but I've only shot below 50 (it was 48) once. I would not shoot below 50 if she was still on lantus.

I also don't think it's a good idea to do the 20% meter variance. Just take a number for what it is and don't be trying to guess if it is a 45 or a 38 or anything else. Sienne had a very valid point that a 35 might be 42 or it might be 28.

 

[KPassa]

I'm going to be interested in how this works out for you. I love non-conformists. :YMHUG:

A few thoughts:

Not sure how the Bayer Contour tests, but I discovered that I was doing unnecessary dose decreases because Mikey really wasn't dropping as low as the Micro was saying. I've since learned the Prime seems much more accurate (i.e. him dropping from 72 to 48 to 28 in an hour on the Micro vs. him dropping from 73 to 56 to 48 on the Prime, with no signs of hypo). So, you might want to look into getting a back-up test meter for those lower numbers and doing a comparison. This might be part of the problem.

I also don't normally decrease Mikey's dose when he hits the 40s. 40s are fine for normal cats so why decrease him when he's not dropping too low? Every time I've decreased him in the past, it's set us back several days to weeks. ECID and with Mikey, his decreases/increases are due to growth spurts, so sometimes he just needs a little extra time to get big enough to handle the full dose. If I do decrease, I also never decrease by .25u any more. Skinnying up his dose, however, is helpful if I'm not going to be around to supervise how well he maintains those 40s (he's highly sensitive and even a skinny vs. full can increase his BG by ~50-100 points). Ever since I stopped being so sensitive to him hitting 40s, it's really stabilized the dosing for us.

Finally, I'm going to start ordering Terumos and using dosing calipers because of this dose sensitivity. If you're not already doing so, this might be helpful for making sure the dose is consistent each day. Speaking of which, even if the dose is consistent each day, there is a doctor who has done a study on how the higher the insulin dose, the less even the absorption rate - with higher doses having a higher variance of absorption. I can't remember where I saw it or read it and will have to do a bit more digging but I think it's something Deb & Wink or BJM posted recently.

 

[KPassa]

Here's some great advice from Libby:

I remember being frustrated that Lucy was pink at AMPS almost every single day, even though she went green at night. Jojo told me not to worry about the pink, she was spending more and more time in green so the little bit of pink didn't matter. She finally got to the point where she was pink for just a few hours every morning. One day she just completely stopped bouncing.

So yes, I would dose to the nadir you want and wait for the numbers to fall into place. If you want nadirs in the 60s (which seems like a good goal), then adjust the dose until the nadirs fall into the 60s. Then STOP. She will eventually start to flatten out. That might take a long time. Once she flattens out, it might be higher than 60s, so you would adjust the dose again to put her back where you want her. If she drops lower than 60s, reduce the dose again to keep her nadirs in that range.

Spend some time studying Mocha's spreadsheet. Devon was good at holding doses once they started doing good things. At one point she held the 3u dose for basically a whole month, with numbers that looked a lot like Gracie's do now. Some other doses on the way down the dosing scale were held about that long because the nadirs were good. Also look at Tuffy - she was on 3.5u for almost 3 months. It took 2 months for her to start to flatten out, but then she headed down the dosing scale.

I added the bold because that statement was :idea: for me.

Yes!!! This is exactly what I've seen over and over again not just with Mikey, but with other cats as well. I've never wanted to mention it out loud because I just figured there was something more esoteric going on and I was simply wrong in my conclusions. "She will eventually start to flatten out" is so absolutely true on so many levels! It's like once you see the nadirs you want, you hold the dose for a bit and their pre-shots drop closer to those nadirs till I've gotten Mikey on some fairly long runs of straight greens (till I screw things up with a fur shot, missed shot, or dose decrease. ). This is when that "Shoot low to stay low" comes in handy.

 

[Wendy&Tiggy(GA)]

furshots = husband. No idea what he is doing wrong. He thinks the shot comes back out the hole he said.. but he is trying to be more careful.

With this

So yes, I would dose to the nadir you want and wait for the numbers to fall into place. If you want nadirs in the 60s (which seems like a good goal), then adjust the dose until the nadirs fall into the 60s. Then STOP. She will eventually start to flatten out. That might take a long time. Once she flattens out, it might be higher than 60s, so you would adjust the dose again to put her back where you want her. If she drops lower than 60s, reduce the dose again to keep her nadirs in that range.

I am sort of doing that anyway - I dose until he goes green. But then after a while on the dose, he flattens out like Libby said but at a yellow level and I increase. and it repeats.

Yes I missed a few mid night tests but I am not convinced it would have made any difference. I have been holding the dose for 6-10 cycles with not enough greens before increasing - its recently been only 6 cycles because I only give 1/4 unit increases and I was advised here that I could go up 1/4 unit every 6 cycles (or 1/2unit every 10 cycles) since his dose is so high that 1/4 unit every 10 is too small and we wanted to be more aggressive.

Maybe I will get more tests in though..

 

[Jill & Alex (GA)]

hi wendy. sienne asked for some eyes on tiggy's spreadsheet and for some thoughts on your new plan. unfortunately, i'm working right now and have to work this evening, so the soonest i can give this the attention it deserves is later tonight.

however, i'd like a little more information because it could affect how i look at what's going on with tiggy. libby will also find the answers to these questions helpful.

• when (at what +hours) do you feed and how much do you feed at each of these times?

• your ss says you've switched to foods with 2% carbs. what % of carbs were you feeding before you switched?

• for the most part, it doesn't look like tiggy gets much of a food spike (if you're feeding him at shot time). would you agree with that statement?

• recently, it looks like tiggy's onset has been a little later than we typically see with most lantus kitties. do you agree? this *could* be because of when he's being fed or *could* mean his onset is later.

• according to your ss, your insulin pen was opened on 03/26. do you have any reason to believe the pen my have been mishandled when you were on vacation? have you examined it closely... holding it up to direct sunlight and looking at it with a magnifying glass for floaties? floaties are difficult to see under the best of circumstances. they're very, very tiny.

• it appears you pretty much shoot on a 12/12 schedule. agree?

would you possibly have the time today to go back over the last few weeks to mark feeding times with an asterisk in the appropriate cell? look at alex's ss for an example. i've divided up her daily calories (for a 24 hour period) into 8 mini-meals. more often than not she'll get two portions at shot times and another two portions fed mid-cycle, but sometimes it varies depending on her cycle. it's helpful to see how food could possibly affect an individual cycle by using an asterisk in the cell to denote feeding times and how much was fed.

like dale, i don't think you're off too much, but i'd like to study tiggy's ss when i have more time tonight. one thing i can say for sure is whenever a caregiver deviates from protocol, the need for testing increases. mid-cycle tests are a must... for each and every cycle. there are pros and cons to being aggressive with the lantus dose versus using a bolus like R in combination with lantus.

sorry i can't stick around for you answers now. work calls, but i'll be back tonight.



EDITED TO ADD: when was tiggy's last wellness check-up with your vet?

 

[KPassa]

Finally, I'm going to start ordering Terumos and using dosing calipers because of this dose sensitivity. If you're not already doing so, this might be helpful for making sure the dose is consistent each day. Speaking of which, even if the dose is consistent each day, there is a doctor who has done a study on how the higher the insulin dose, the less even the absorption rate - with higher doses having a higher variance of absorption. I can't remember where I saw it or read it and will have to do a bit more digging but I think it's something Deb & Wink or BJM posted recently.

Here it is! It was actually Venita who posted it.

 

[Wendy&Tiggy(GA)]

Hi! Thanks again everyone for taking such a close look at this.

- when (at what +hours) do you feed and how much do you feed at each of these times? He free feeds pretty much all day. Every few hours he has a mini meal. Day and night. total of maybe 4 cans of FF a day ( he is 17lbs)

- your ss says you've switched to foods with 2% carbs. what % of carbs were you feeding before you switched?I have to change that back. We ran out after two days and i need to get more. He is back on the FF 3 and 4% pates. Freeze dried chicken treats. No dry in the house

- for the most part, it doesn't look like tiggy gets much of a food spike (if you're feeding him at shot time). would you agree with that statement? Yes - he doesnt spike at all but hard to tell I guess since he grazes all day. Edited to add: the few times I measured within an hour of food that I know of, if anything he had gone down a little.

- recently, it looks like tiggy's onset has been a little later than we typically see with most lantus kitties. do you agree? this *could* be because of when he's being fed or *could* mean his onset is later. Onset? I really dont see much of a curve with him at all - he goes up and down bouncing almost independently of the shot... I dont see the curve that I do with Bailey.

- according to your ss, your insulin pen was opened on 03/26. do you have any reason to believe the pen my have been mishandled when you were on vacation? have you examined it closely... My bad again on updating the SS- we are on our second pen since then. At almost 16 units a day we go through them in a few weeks.and we keep them in the fridge etc

- it appears you pretty much shoot on a 12/12 schedule. agree? yep within 15 minutes.

would you possibly have the time today to go back over the last few weeks to mark feeding times with an asterisk in the appropriate cell? no idea since he free feeds.

like dale, i don't think you're off too much, but i'd like to study tiggy's ss when i have more time tonight. one thing i can say for sure is whenever a caregiver deviates from protocol, the need for testing increases. mid-cycle tests are a must... for each and every cycle. there are pros and cons to being aggressive with the lantus dose versus using a bolus like R in combination with lantus.

i fixed my sheet!

Edited to add: Hasnt been at the vet since November when he had his tumor removed and he had full blood panel then. He was already at 4.5units then. No sign of recurrence of tumour. No sign of UTI or ear infections that we can tell. Only issue he has is occasional softer stool which he has had since we moved him to wet a year ago. No ketones.

Wendy

 

[KPassa]

furshots = husband. No idea what he is doing wrong. He thinks the shot comes back out the hole he said.. but he is trying to be more careful.

It sounds like he might not be inserting the needle deep enough or far enough back if it's leaking back out. Are you using long or short needles? It might be easier for Hubby's "technique" to use the longer needles to get the insulin farther away from the needle entrance. One thing I do when training new shooters for Mikey is use an apple cut in half and have them try to insert the needle at a shallow enough depth that it's just below the surface of the apple skin (not too deep) and so they can see the angle of penetration through the cut portion of the apple. Some of them have better technique with the shorter needle, some with the longer (I personally have better technique with the longer needle). It really helps them visualize what the needle would look like under Michelangelo's skin.

 

[Jill & Alex (GA)]

I am being naughty. I am not obeying the protocol right now and am looking forward to what people have to say about it. Since the last year I have pretty much been obeying the protocol but Tiggy has been slowly increasing his dose. He looks to me to have a fairly unusual pattern and I want to experiment with something else. i.e.

1. Gets an increase
2. gets nice greens one day, followed by a bounce to pink or high yellow the next
3. repeat of greens/blues to pink bounces
4. gradually nice greens go away and earns another increase - now he is at 8.

I am wondering if he is just spending too much time in the bounce that its causing the toxicity which is why he slowly creeps up. So I didnt wait this time and increased him 1/2IU after three days since I wasnt seeing as much blues or greens as I would like.

no, you're not being naughty. you've been following the TR protocol for quite some time without seeing the results you'd like. the TR protocol is a great place to start, but not every kitty falls in line as quickly as we'd like. sometimes we have to figure out what will work and that often involves some trial and error before we get it right.

that said, since last november was tiggy's last wellness checkup, it would probably be a good idea to bring him in for an examination and to have blood work drawn. it's possible something is going on with tiggy that you may not be aware of. it's also the time to discuss having tiggy tested for a High Dose condition with your vet. i think it would be very helpful to know because knowing could give you a green light to become more aggressive than usual.

feeding: imho, caregivers with kitties who are free fed are at a little bit of a disadvantage when it comes to having the ability to manage a curve. feeding small mini-meals at specified times times was easy with alex, but i have a civvie that who never go along with it. do you think tiggy would adjust to being fed mini-meals at specified times? would it be possible?

So my plan - this is non compliant to the TR protocol. I am also basing this on the fact that currently I reduce under 40 or under 50 with a stall. But isnt that number a little dependent on the meter and its 20% variance? so I am going to alter my reduction thresholds. I am going to do this for a week or so see how it goes.

1. I will keep increasing 1/2IU every 3 days unless he is spending most of his time (2/3 of the time) in blue green, or he goes very low as per below.
2. I wont reduce unless he goes 20% under 40 ie 35. (20% under 40 is actually 33 but that scares me)
3. I wont stall unless he is under 35 - before my stall number was 50. But I will get a 30 min pretest before each pre shot just in case he is dropping and if he is 35 and dropping, then i will stall.
4. I will be testing a LOT. and lots of high carb/syrup at the ready.

Thoughts? If this doesnt work, I am going to go with the R which I have on order.

you asked for thoughts so here goes...

increasing the dose: i agree with increasing the dose in increments of 0.5 unit given tiggy's current dose. i seriously question the wisdom in aggressive dosing (as you've described) when kitty is throwing greens. it seems pretty risky given the lack of a food spike and the fact that he is not necessarily as predictable as you seem to think.

i'd much rather see you incorporate the use of R until you reach tiggy's optimal dose... initially at the beginning of a bounce. there's also the possibility of using some R in a subsequent cycle or two as long as we're sure the bounce is not about to break. we'd have to play that one by ear.

taking reductions: i'm uncomfortable when any kitty is riding in or dropping into 30s. there's not much margin for error in the 30s.

i've seen so many caregivers say something along the lines of "my kitty is fine in the 30s. no symptoms. acting normal." that may be true, but what about the next time? just because a kitty is fine in the 30s one day doesn't mean that they'll always be fine in the 30s.

sienne mentioned the option to reduce the dose when kitty's numbers fall between 40 - 50 three times or below 40 once. i think this makes a whole lot of sense for tiggy.

imho, a drop into the 30s when you're shooting on a 12/12 schedule is a good indication a reduction is warranted. when you're shooting as much insulin as you are reducing by a quarter unit is kind of like shaving the dose for a kitty on a 1 or 2u dose. kwim?

stalling: i'm not a big fan of stalling. imho, in most cases caregivers are better off shooting 12/12 as long as the preshot number is over 50 with lantus. using under 35 as a stall number makes me very, very nervous... especially with tiggy because he doesn't appear to get much of a food spike. ann suggested reducing your stall number to 45. i like that idea. why don't you give it a try before taking your stall number all the way down to 35.




if tiggy were mine and given his data, i'd take him in for an exam & blood work. for the time being i would increase the dose in increments of 0.5 unit after every 6 cycles unless tiggy's numbers tell me otherwise. i'd incorporate the use of R to help with bounces. i'd stall if preshot numbers were less than 50. i'd take 0.25u reductions after kitty drops below 50 three times or once under 40. these things would be subject to change as tiggy changes. after all, it's tiggy who's leading this dance. :mrgreen:


the syringe is in your hands. when dosing aggressively, remember to be just as aggressive with testing.



just a few thoughts for your consideration... others may think differently.

 

[Libby and Lucy]

if tiggy were mine and given his data, i'd take him in for an exam & blood work. for the time being i would increase the dose in increments of 0.5 unit after every 6 cycles unless tiggy's numbers tell me otherwise. i'd incorporate the use of R to help with bounces. i'd stall if preshot numbers were less than 50. i'd take 0.25u reductions after kitty drops below 50 three times or once under 40. these things would be subject to change as tiggy changes. after all, it's tiggy who's leading this dance. :mrgreen:

the syringe is in your hands. when dosing aggressively, remember to be just as aggressive with testing.

Jill always sums things up so nicely. I agree with her plan, but I'll also throw in that increasing every 6 cycles by 0.5u assumes that you will be getting enough spot checks during those 6 cycles to be sure you know what is going on. For example, in the increase from 7.5u to 8u, you only had one cycle with spot checks and that was a cycle in which a bounce was beginning. Just be alert, and if 6 cycles have gone by and you haven't been able to get sufficient spot checks, don't increase the dose until you do. Try hard to keep doing the spot checks so you don't have to wait to increase, though. I think moving faster will probably help, but you need to do the due diligence too.

I also agree that many of us get to a point at which we are deviating from the protocol based on what our data shows us. It's good to think things through and figure out the best course of action for your cat. I don't think I would mess with the lows, though. Shooting in the 30s scares me for ANY cat, but on a higher dose with a cat that can be hard to bring up, I wouldn't chance it. Adding a feeding later in the cycle might help prop him up so he doesn't go so low, though.

 

[Lisa & Leo]

We also started following the "three times below 50" and even then sometimes only shaved the dose reduction. Depended on the situation, but Leo was really bouncy and only sometimes had a mid-cycle nadir. Many times his low value was a shot time, and I would stall just to make sure he wasn't still decreasing, and sometimes I screwed up and was dealing with lower numbers and glad I stalled.

Regarding leakage ... when I shoot Molly with B-12, the area around her scruff seems to leak the B-12 back out, so I shoot that on he shoulder/flank and it helps. Maybe because she's older? Or that's just her skin? Or the granulomas or something I've heard mentioned? So maybe a thought is to try shooting in a non-scruff area and see if that stops the leakage based on whatever different technique your DH seems to be using.

I would agree that ECID and adjusting the protocol as you think might help, but glad you are bouncing it off the group. We committed some other sins too that I won't mention unless they seem relevant

Good Luck!

 

[Angela & Blackie & 3 Others]

I have to agree with Sienne's comment about waiting for Tiggy to hit 3x in the 40's or once below 40. I also follow that protocol with Blackie, and never gone wrong with it.

One thing about meter variance is that it could be that your meter is like one of mine... Perhaps it's reading too high. Try getting the Relion Prime (it's only $16.someting at Walmart, and the strips are $9.00/box), and do a comparison with the one you're using. I found that my Maxima was reading too high, and the Prime was reading more correctly. It can't hurt!

If you've switched to 2% carbs, it'll take some time for Tiggy's body to adjust to the new food, too. Everything is trial and error.