Angel's numbers

[Lisa and Angel]

Looking at her recent data, I've been thinking about something. Might it be better for her to get a higher dose at AMPS (barring low preshots), and then a lower dose at PMPS?

I know it's unconventional, but she's still diving too low in the PM cycles, while her current dose doesn't seem like enough for the AM cycles. We've had a lot of skips/reductions at AM due to low preshots, but it seems like her last effective AM dose was at around 3U. We're at 2.25U now due to another lime green yesterday PM.

Hoping to get some expert opinions on this.

 

[.:. in.active .:.]

I'm tagging @Elizabeth and Bertie because I can briefly recall seeing "sliding scale dosing" in her signature.
I only just started to study this topic a few days ago, and yet to dive deeper, so I consider myself unfamiliar with it, however, I'd be interested to see/hear more about it, should it be relevant to Angel as well. (If not, I'm happy to open a new thread on this topic, so I'm not clogging Lisa's.)

 

[Suzanne & Darcy]

Right now, I think it would be a good idea to see if you can stabilize her on the 2.25 units. I think that if you would make it a habit to get a +2 and/or +3 test in the evening cycle, you could get a "heads up" that she is dropping and you could intervene to prevent her from going into the lime green territory.

Also, now that she is on a lower dose, it will hopefully be possible to lower her pre-shot number where you can shoot the full dose -- as you gather data.

I think it may be premature at this point to consider an official "sliding scale" although you already are making accommodations for very low preshot numbers, so in a way you are "sliding." As you get more data, we may (only if necessary) be able to develop a more official recommendation for how much to shoot when. How's everything else going? How are you doing?

 

[Lisa and Angel]

Right now, I think it would be a good idea to see if you can stabilize her on the 2.25 units. I think that if you would make it a habit to get a +2 and/or +3 test in the evening cycle, you could get a "heads up" that she is dropping and you could intervene to prevent her from going into the lime green territory.

Yeah, about that... she's at 3.2 again at PMPS. So that's officially another reduction. Didn't expect that after her nice 4.9 at +7. Her nadir seems to be getting later and later. She definitely ate well in the last couple hours too!

I'd love to stabilize her on a dose but she's just diving down at breakneck speed lol. I will get some +2/+3s in! Testing is going better than before, so I hope she'll be tolerant of me upping our testing game.

Also, now that she is on a lower dose, it will hopefully be possible to lower her pre-shot number where you can shoot the full dose -- as you gather data.

At this moment with 3.2 I'm not too sure whether to skip or shoot- and then reduced or full dose. What do you think? I 100% agree with you on shooting lower, but this is the lowest preshot I've ever gotten and I'm not sure what to do.

I think it may be premature at this point to consider an official "sliding scale" although you already are making accommodations for very low preshot numbers, so in a way you are "sliding." As you get more data, we may (only if necessary) be able to develop a more official recommendation for how much to shoot when. How's everything else going? How are you doing?

I see your point, I might be getting ahead of myself with the sliding scale dosing. Just don't like seeing her in the pinks. I'll keep doing what we've been doing according to SLGS.

As for everything else, I'm still sick but getting better thankfully. Angel's low numbers don't scare me much anymore due to overexposure, I'm not quite sure if that's a good or a bad thing tbh.

Angel's doing well all things considered. Clinical signs of the diabetes have nearly vanished, she's feeling a lot more comfortable. A lot of things I'd attributed to the Pregabalin, like her lethargy and not grooming much anymore, have improved! Unfortunately still some persistant stool issues. She's lost some weight (from 6kg to 5.75kg), not a bad thing considering she's still overweight but something to keep an eye on.

 

[Lisa and Angel]

For now, I think I'll skip this shot. Shooting when she's this low just doesn't sound like a good idea right now. I'll get some tests in before I go to bed to kinda see what's up (when she starts to go up again and how fast). I'd like more AM data just to get confident enough to shoot low numbers. Yesterday's AM showed no nadir at all with full dose, but I can't be sure that's the norm.

 

[Lisa and Angel]

Question:

Last night, she went up enough in numbers that I could've given her a full dose several hours later. However, it's just not feasible to keep delaying each shot by multiple hours, especially when this is happening regularly.

In situations like this, would it be okay to deviate from the 12/12 schedule by giving the AM shot later and still keeping the PM shot on time (so maybe only 9-10 hours after the last shot)? Or would that just cause an extra hard dive in the PM cycle? I've read the dosing methods sticky part on 11/13 or 13/11 dosing, and the part about "smoothing out the cycle to get back to two shootable numbers every 12 hours" appeals to me because I do think that having to skip or shoot token doses so often is messing her up.

I'd also like some input about what preshot level would be safe to shoot, given the data we currently have. I think I'd feel pretty safe about shooting a token dose if she's around 5, and full dose if she's at 8 (maybe 6-7 if she's trending upwards), but let me know what ya'll think.

 

[Lisa and Angel]

I'm afraid we're gonna be in for a rough ride this cycle. I shot a token dose of 0.5U on the presumption that she'd rise quickly after preshot like she usually does, but she's already DOWN to 3.3 at +3.

Edit: it actually turned out to be a really nice surf! Seems the token dose was the right choice after all.

 

[Suzanne & Darcy]

I’m glad that on the evening cycle you shot a small dose instead of skipping because it helped her to stay lower and surf in green. But I am unsure why, when she was in pink today, you reduced her dose. Anyway, I hope it will go well.

 

[Lisa and Angel]

She went below 5 in both the AM and PM cycle, wasn't a reduction appropriate?

 

[Shelley & Jess]

Was looking to see how Angel was doing on 1.75 units and notice your spreadsheet isn't updated. How did the vet appointment go - is the diarrhea any better?

 

[Lisa and Angel]

Was looking to see how Angel was doing on 1.75 units and notice your spreadsheet isn't updated. How did the vet appointment go - is the diarrhea any better?

Unfortunately Angel is very very sick. I'm posting a thread in feline health for more visibility, please check there for details (I'll add a link once I've posted- if I remember).

 

[Shelley & Jess]

Thanks for letting us know - here's the thread, Please help, Angel is very very sick (vet involved).

I won't be much help, but, please know, I'm thinking of you and Angel.

@Suzanne & Darcy can you peek at the blood work file Lisa posted in the linked thread?

 

[Lisa and Angel]

Things are getting back to normal around here. Stools aren't perfect yet, but besides that she's doing and feeling great!

I've also got her eating a lot more wet food, I'd say she's at 80% wet vs. 20% dry now on a daily basis. Variable carbs (most between 0% to 14%, some higher) in the wet food, high carbs in the dry food. I'm wondering whether this is a bad thing? Switching between eating (for example) 4% carb wet and 33% carb dry, I can't help but think that could contribute to big fluctuations in her BG...

------

About insulin:

I've had her on 1.25U for a week, but her numbers haven't been so good yet. So today, I thought I'd increase her to 1.5U. But as you can see on the SS, she went a tad too low. Not dramatically, but I already slowed her down with dry food and at night I won't be around to do that (she can freefeed on dry or wet, but I can't be certain that she'll do so).

Now I'm wondering what to do with her next dose (assuming she'll get to a safe PS, otherwise I know to skip or shoot a token dose)?
Following SLGS rules, I should decrease back to 1.25U again, but that didn't seem like enough. Maybe a skinny 1.5/fat 1.25? @Suzanne & Darcy would love your thoughts on this.

 

[Suzanne & Darcy]

Regarding tonight’s cycle. When you caught the big drop at +2, it would have been a good time to purposefully get her to eat - perhaps even some of those 14 percent carbs you mentioned - to slow her down.

Switching between eating (for example) 4% carb wet and 33% carb dry, I can't help but think that could contribute to big fluctuations in her BG...

This is a possibility. You could definitely try skinny-ing the dose you gave tonight. Her nadir of 83 in the p.m. cycle is actually an excellent nadir that you would be happy to see if following MPM, but just barely lower than our goal for SLGS. Sp all on all I think she’s doing well, and I am so happy to see this!

 

[Lisa and Angel]

Regarding tonight’s cycle. When you caught the big drop at +2, it would have been a good time to purposefully get her to eat - perhaps even some of those 14 percent carbs you mentioned - to slow her down.

Ahh, forgot to note it in the spreadsheet, but she gets her S. boulardii mixed into some wet food at each +2, so she definitely ate. Can't quite remember which food/how much carbs though, I'll make sure it's a medium carb one from now on for this.

This is a possibility. You could definitely try skinny-ing the dose you gave tonight. Her nadir of 83 in the p.m. cycle is actually an excellent nadir that you would be happy to see if following MPM, but just barely lower than our goal for SLGS. Sp all on all I think she’s doing well, and I am so happy to see this!

I ended up giving her a fat 1.25/skinny 1.5 (aimed for halfway between 1.25 and 1.5, microdosing is hard).

I do really like this cycle's nadir and overall surf! But this was with constant "food buffering" to keep her from dropping too low, and I wouldn't be able to do that at night. I'll be extra cautious the next couple cycles.


I'll be going to the pet store on tuesday to buy some more wet food since I'm running low. And I'm wondering if the carb content matters much if I still have dry high carb food out? Should I still aim for a specific range (low carb or maybe medium carb?), exclude too high/low or just buy what she likes?

About 70% of the food she's eating now is paté from a local store's own brand line. She likes all the flavours, but they all have different carb contents. Some 4%, some 8%, some 11%, some 14% and some 18%. If it's not important, I'll get them all for variety's sake, but if I'm better off avoiding some then I won't buy them.

 

[Lisa and Angel]

Back again with a pantry full of wet food. I just got all kinds, figured it'd be fine. And if not, there's always my other cats who'd be happy to help eat it up.

So we have another low today, despite feeding medium carbs at +2, +3, +4 and +5 (small grazing wet food meals). What should my reduction be from fat 1.25? Down to regular 1.25 or lower?

Edit: I have a box of U-100 syringes that I bought a couple months ago when I still thought we'd have to switch to Lantus. I'm considering switching to those syringes to be more accurate with dosing. I've read the conversion chart, but will spend a day or 2 studying this and training with some U-100 syringes (with water, just drawing it up, no Angel involved) just to make sure no mistakes will occur.

 

[Suzanne & Darcy]

Hi

Back again with a pantry full of wet food. I just got all kinds, figured it'd be fine. And if not, there's always my other cats who'd be happy to help eat it up.

So we have another low today, despite feeding medium carbs at +2, +3, +4 and +5 (small grazing wet food meals). What should my reduction be from fat 1.25? Down to regular 1.25 or lower?

Edit: I have a box of U-100 syringes that I bought a couple months ago when I still thought we'd have to switch to Lantus. I'm considering switching to those syringes to be more accurate with dosing. I've read the conversion chart, but will spend a day or 2 studying this and training with some U-100 syringes (with water, just drawing it up, no Angel involved) just to make sure no mistakes will occur.

I’m not sure what you decided, but if it were my cat — because her low was only 58, which is quite a safe number— I would just reduce back down to 1.25 units

 

[Suzanne & Darcy]

Back again with a pantry full of wet food. I just got all kinds, figured it'd be fine. And if not, there's always my other cats who'd be happy to help eat it up.

So we have another low today, despite feeding medium carbs at +2, +3, +4 and +5 (small grazing wet food meals). What should my reduction be from fat 1.25? Down to regular 1.25 or lower?

Edit: I have a box of U-100 syringes that I bought a couple months ago when I still thought we'd have to switch to Lantus. I'm considering switching to those syringes to be more accurate with dosing. I've read the conversion chart, but will spend a day or 2 studying this and training with some U-100 syringes (with water, just drawing it up, no Angel involved) just to make sure no mistakes will occur.

Good about the U-100 syringes and studying the conversion chart.

May I ask what carb percentages you were feeding yesterday at +2,3,4,5?

And again, it’s actually a very good cycle (yesterday’s p.m. cycle.)

 

[Lisa and Angel]

Sorry @Suzanne & Darcy, for some reason I didn't get an alert about your reply!

It's been a while, and Angel's not doing so great. Sept 5th was the last time she hit green. I increased by 0.2 instead of 0.25, since I'm using the U-100 syringes now, is that okay? I think she'll need another increase though. This is really frustrating, feels like we were on the road to remission and now we've lost the way entirely.

Her clinical symptoms of diabetes are back again too. Drinking extremely often, huge and frequent pees, desperately hungry. She's also showing neuropathy in her front legs:

She got a couple of B12 shots when she got so sick, so I don't think this is due to a deficiency. She had minor neuropathy prior to regulation too, so I think this is purely because her glucose has been so high.

I don't know what to do. Should I wait out the full week on 1.4 or increase her sooner?

 

[Suzanne & Darcy]

Honestly, I am away from home for a family wedding in NYC. But, I look at Angel’s spreadsheet and it looks like she needs an increase. I would like to see her in better numbers. If you have not seen some better numbers after six cycles (and I think it will be six cycles after this evening cycle?) then I would increase. You test enough to follow MPM. But you should read the portion of the dosing methods sticky note to make up your mind. I think that, with Angel’s history, I am definitely concerned to see her numbers come down. But we need to jump on it.

 

[Suzanne & Darcy]

Another thing, she is absolutely gorgeous. What can you do to get more calories into her? She looks underweight. I know how hard it is to get weight onto a senior cat, believe me!

 

[Lisa and Angel]

Honestly, I am away from home for a family wedding in NYC. But, I look at Angel’s spreadsheet and it looks like she needs an increase. I would like to see her in better numbers. If you have not seen some better numbers after six cycles (and I think it will be six cycles after this evening cycle?) then I would increase. You test enough to follow MPM. But you should read the portion of the dosing methods sticky note to make up your mind. I think that, with Angel’s history, I am definitely concerned to see her numbers come down. But we need to jump on it.

Fun, enjoy the wedding! I would also like to see her in better numbers, and especially feeling better again. And yes, tonight is cycle number 6 on this dose. She had a yellow AMPS for the first time in a while, though still a high yellow. +3 is a mid yellow like the nights before. Not sure if this counts as better numbers? My gut feeling says no. I'll check back here tomorrow before PMPS just to check if you say yes/no to the increase based on these numbers. If you haven't gotten the chance to reply back, I'll use my best judgement and probably do the increase.

MPM seems doable, but it says that the cat must be on a canned/raw diet. Angel's diet is roughly 90% canned now, but dry food is still left out for my other cats and she does sometimes snack on it. Now sure if that disqualifies her?

Another thing, she is absolutely gorgeous. What can you do to get more calories into her? She looks underweight. I know how hard it is to get weight onto a senior cat, believe me!

Thank you! She's actually still overweight! She just lost a lot of muscle mass during her illness and she carries all her fat in her belly it seems. As for food, she's back to being an absolute menace. She'll eat pretty much anything I put in front of her, and she'd eat most of my food as well if it was up to her. I'm lucky she likes wet food so much more than dry. I think she's averaging about 400 to 500 grams of wet food a day, which is a whole lot but she's got both the diabetes, and the Pregabalin, driving up her appetite. Weight has been stable for the last 2-ish weeks (prior to illness she was 6kg, she went down to 5.1kg when she was so sick, started gaining again when she recovered and has hovered at around 5.5kg these last few weeks, which is about 1kg above her target weight).

 

[Suzanne & Darcy]

Well let’s see what she does tonight. I would like to see more blue. So even though you can’t follow MPM right now, I still think, for now, that if she doesn’t see some blue tonight that she would be safe if you increased to 1.6 (drawing to the 4 unit mark on the U-100 syringe.). For others who may be reading along, this recommendation is very specific to Angel’s situation and takes into account her recent health challenges and hospitalization. Let me know what you think. I will be flying back home tomorrow and also picking cats up from the vet where they were boarded, but I will check in later in the afternoon to see how y’all are doing.

 

[Lisa and Angel]

Welp, I stayed up to get a +6 again and she surprised me with a 5.5! I guess threatening an increase really does work lol. Safe to say we'll stay at 1.4 for a bit longer. Have a safe flight tomorrow!