Another dosing question - Pedey's numbers keep dropping/skipping doses

Fortunately we don't think there have been any hypos, but it's crazy! As you can see per his spreadsheet, we are now down to 1 unit per day but he earned another dose reduction this morning/early afternoon.

This seems so strange to us and often he's too low for us to shoot (under 130). This morning, we shot anyways because we were home to monitor at 116 just because we are really worried regarding lack of consistency on dosing and he went down to 68, so we'll reduce dose to .75.

Is it possible he's approaching remission? What exactly constitutes remission? And can anyone advise as to when we need to be worried about hypoglycemia (what number is that?)?

Thank you all!!!

 

He's looking good!

So for remission we just step down the dose as reductions are earned; so from 0.75, to 0.5, to 0.25, then depending on numbers 0.1U or a drop dose. Once they earn a reduction on drop dose to 0.1U, that's when we'd look at an OTJ trial (though for some cats their numbers are still too high overall, which would warrant a possible insulin switch...cross that bridge later).

An OTJ trial is 14 days without insulin, and ideally we want to see nearly all green numbers. That will be difficult following SLGS, so we would look for numbers to be under 120. Remissions tend to be stronger and longer lasting when they're in all green, however.

It's a little too soon to say if he's heading for remission, but his SS looks promising. But I've had a few cats stall out at a 0.25U-0.5U dose for months.

We really don't want him under 68 on an AlphaTrak while following SLGS. I would actually reduce to 0.5U and see if that's a little easier to shoot twice a day.


It's hard to give concrete "do this at this number" because it really depends where the number is in the cycle (early? Close to nadir?) as well as how far it's dropped in how much time. Always best to post and ask for help if you get something under 80.

Some loose guidance:
Any number under 68 on AT needs high carb (15-20%) food, ideally wet food. Start with 1-2 tsp and test again in 30 mins. Repeat until in the 70s, switch to medium carb (10-15%) food still testing every 30 mins. Above that hold off on food but continue to test every 30-60 mins in case he continues to drop.

Any number under 55-60 ish add honey to the HC, test in 15 mins. Repeat til above 68, follow advice above

https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

Hi there, with today's drop please remember to reduce by at least 0.25U (so your new dose is 0.75U).

 

Thank you so much @FrostD! Sorry I've been MIA - got admitted to the hospital again with another bleed. We are getting some super confusing (but possibly very positive numbers). We shot at .5U our last time he got a shot (Friday/yesterday morning) and then he earned a reduction that afternoon, but I was in the hospital and he was relatively low at night so we didn't shoot to be safe since we weren't sure if my husband would be home to monitor.

We will reduce to .25U (super hard to measure! need to get one of the pens ASAP) for this morning's shot and keep our fingers crossed. I'm back home thankfully under strict orders to return with more bleeding, but we are optimistic we can keep an eye on him today.

Thank you thank you thank you!

 

I'm sorry about that, bleeding during pregnancy is so unbelievably stressful. I've had that with all 3 of mine, but so far lucky that it's just been clots away from the baby that end up resolving.

Not sure what you mean by one of the pens? If you mean getting the pen needles, if I remember correctly I think those can only do whole unit increases.

 

The pens, if you use the needles, only allow you to dose in 1.0u increments like Melissa indicated.

 

Oh, shoot. For some reason I thought that you could use a syringe to pull more accurate smaller increments out. Well, you all saved me a bit of money as we will stick to the vial.

 

You can use a syringe with the pens just like a vial.

 

Hi everyone,

We got an 88 today after a few days of .25U. Long story but for a few weeks Pedey was refusing to eat so we bought some Tiki Cat as we were getting worried. Sophie our non-diabetic cat loved it, but Pedey wouldn't touch it, so we kept giving him Dr. Elsey's but put the Tiki Cat out for Sophie. For weeks he never touched the Tiki Cat but a few days ago we caught him chowing down on it, so I think that resulted in his relatively higher numbers for a few days (130s).

Took away the Tiki Cat (sorry Sophie) and now the numbers are looking much better and he's eating more wet food again. We think we are going to stick to .25U for a few days longer to try and get him to eat more wet food/less Dr. Elsey's and do an OTJ trial.

Would welcome all of your input @FrostD @tiffmaxee @Sienne and Gabby (GA) and anyone else on our plan!

 

With SLGS that is technically a reduction (especially since we don't know how low he may have gone today).

I would actually start posting over in the Lantus forum. The next step down is technically 0.1U, Elise would be better to advise.

 

I thought most of the Tiki cat flavors were like, super low carb

 

Reduce to .10 in the morning. The pet meter reads a little higher than a human meter but even so I don’t think he is ready for an OTJ trial. You want mostly BG under 120.

 

Thanks all! I will start posting on the Lantus forum - I'm a little terrified because having trouble following it but that's how I started this whole journey.

How do you all get a .10U dose? We are having trouble seeing the .25U on the syringe that has .50 increments!

Also, @Hendrick Cuddleclaw, maybe I'm wrong? I think Dr. Elsey's is under 10% carbs while Tiki is around 17% for the chicken and egg we got...but honestly I could be mistaken.

 

When you post on the lantus we post this way, and do a new post everyday
You can introduce yourself and say you were previously posting on the Main Health
Date, Pedey, AMPS # then any tests you do after then PMPS#, any tests after that
You will also link the previous days post to your new one just copy and paste it
You will find it all the way up top , where you see the pic of that cat, it will be in that long line above

To add more tests to your title look to the right you will see Thread Tools tap in that then tap in Edit Thread, add your tests and hit save changes

Here is your previous post
https://www.felinediabetes.com/FDMB/threads/numbers-below-150-consistently-pmps.262068/#post-2939241

 

You said to repeat until in the 70s, then switch to medium carb and above that, hold off on food. I'm just curious, above what? At what number would someone hold off on food and continue to test?

 

80s on an AT roughly. The main reason being is if they drop again you still need them hungry, but also you want to keep them surfing in those greens as long as possible.

The other thing to consider is when is it in the cycle? If a cat has a nadir typically at +7, and there's a drop from say 130 to 85 at +2...that's handled a little differently.

 

Thank you so much! I screenshotted your post to have in the future if needed. This is the most helpful information including numbers that I've found. When someone who isn't used to low numbers begins to panic (me), having a detailed list of what to do can make all the difference to them.

 

You also want them to surf or go up for two hours without food if approaching your reduction point or if they earn a reduction on that cycle.

 

No problem. Like I said above, always best to ask for help until you get the hang of it, but the loose guidance helps in a pinch. Always err on the side of more carbs and frequent testing...and like Elise said, you want them flat or rising for 2 hours without food (so as food wears off you're sure he's holding steady and not dropping again)

 

Thank you ladies, that's good to know. I know you were supposed to test to make sure they didn't drop again, but I didn't know it was supposed to be after 2 hours (or why).

 

Sheena --

I didn't see any flavors of Tiki Cat on Dr. Lisa's list that isn't low carb. I'm not sure what the chicken and egg flavor goes by though, since they all have cute names. Sometimes, it's a matter of a change in food that may cause a rise in numbers even if the new food is low in carbs. It can take a few days for a cat's system to adjust.

 

@SaraMV Aren't they all the best? I'm so slow to understand all of this but I feel like I've made worlds of progress under this group's tutelage.

Going to move over to Lantus tomorrow @Diane Tyler's Mom.

@Sienne and Gabby (GA) - ah, could it be that I'm talking dry food (I know, not great, we are working very hard to convert our former kibble addict) compared to your Tiki Cat wet food? Dr. Lisa doesn't include any dry on her list, right?

 

Not Sienne but eliminating dry for a lot of cats gets them diet controlled and all that can eliminate dry have lower bg. Eating is essential so until he eats enough wet food don’t stop feeding dry. Dr. Lisa is opposed to feeding dry. There have been some here over the years I have read that have their bg go up from some proteins. If you make multiple changes at the same time you won’t know whether it’s Tiki or the dry food causing a spike. JMHO.

 

Great, Just a reminder I showed you how to post on the lanus board on my post # 15
The post numbers are to the right of each post

Your previous post
https://felinediabetes.com/FDMB/threads/numbers-below-150-consistently-pmps.262068/#post-2939241

 

I just wanted to thank you again flor this information. I ended up meeting it tonight for Taz and it was beyond helpful! I think there should be a special post on top of each forum with information like this. For AT, and human meters.

 

This is in the yellow stickies in the Lantus forum
HOW TO HANDLE LOW NUMBERS