Hey all, It's been a while since I've posted. On the last episode, I had mentioned that Avery was going in to have a tooth extraction. Well, tooth turned to teeth and he had to have the canines on the left side removed after the dentist took X-ray. Anyway, we were really hoping he'd be better regulated after the surgery but alas... Anyway, he's recovered and soooo lovable again. I mean, he was always lovable but now he wants affection from us. Besides the surgery, I've awoken to a hypo episode where he was extremely disoriented. His AMPS was 47 despite appearing within a very normal range the night before. He's better now and his nadirs were decent for most of Jan/Feb but we're seeing a lot of variance. Now, I will admit that I've been dose-surfing a bit so you'll see a lot of doses between 2 and 2.75. Eventually I stopped and try to stick to 2.5 and only drop if his pre-test numbers are low. However, there are multiple tests in between shots where he's testing in the 400's. Initially I thought they were just bounces but I can't explain everything away as a bounce and I've (for the mosty part) have been keeping him at 2.5u). He appeared to be doing very well today, I gave him his usual PM shot and at +3 and +5 he's testing at 400, up almost 200 points from his PMPS around 200. I don't know what to do anymore. His diabetes is... aggressive. Fighting to stay in the 400's. If his diabetes were a person I would do violent things to it that would get me arrested. I don't know if I'm overthinking things but his numbers are bizarre. I never know what I'm going to expect - sometimes a 2.5 is perfect, other times it drops him slightly under 50 points, and other times it has no effect. We're feeding him Weruva BFF (less than 10% carbs) and hydrating small chunks of single-ingredient freeze-dried food as a snack. Here's his feeding: 09AM: Test, 3.5oz of Weruva chicken and shot 03PM: Test + 1.5 oz of Weruva chicken 09PM: Test, 3.5oz of Weruva chicken and shot 12AM: Test + 1.5 oz of Weruva chicken 02AM: half a brick of hydrated freeze dried food He's a little over 10 lbs so he's getting his body weight in food and gets no kibble. Additionally, I noticed that towards the end of our previous bottle of ProZinc he wasn't getting much better. It was honestly like I wasn't giving him a shot. I tested from a newly purchased vial and he appeared to respond immediately. I asked on the FB group if this is typical of ProZinc and many members mentioned that ProZinc can sort of poop out towards the end of a vial. So yeah, I through out the remainder and just switched to the new vial. Now it's happening again and sometimes he respond very well and other times it's like I'm skipping a shot. I'm very careful not to get fur shots and tend to inspect for any wet fur after I'm done. Now, everything else appears normal. He's eating, drinking water, cuddling and using the box. He had bloodwork done in Jan before his surgery. So what am I doing wrong if anything? Should we start to consider switching to Lantus? He can get better on ProZinc but it's so volatile that it feels like a coin flip as to where his numbers land. Idk I'm considering raising to 2.75u but I'm worried because the 2.5u does the job most of the time. I've tried to go down to 2.25u but it doesn't seem to be enough. I drop to 2u/2.25u when his pre-shot numbers are already in the green. I'm happy we're getting as many greens as we are reds but the variance is startling and sometimes his BG goes up after his shot. Long term, I don't want to stress his organs as he remains in high numbers 50% of the time... I feel like I'm going insane. I'm gonna tag @Sharon555 so we can cry together.
Wow. That is a lot to take in. I have read your post and I do appreciate your thoroughness. Let me look at the spreadsheet now.
Hi again. I am looking at the spreadsheet and honestly I am having trouble interpreting things because there really aren’t enough tests for me to see what is going on. Would you be able to get any more tests earlier in the cycle than +6? I can tell there’s a lot going on between shot time and +6 but I don’t know what. I think tAvery may be dropping too low at points and then bouncing back up. I’m sorry to say this and I know it’s not what you want to hear! I really want to help, but we need to try sticking with a dose and then trying to get more midcycle tests. Tell me if you are at home to do this or not. And if not, would a Libre continuous glucose monitor be an option?
And as to the feeding, would it be possible to feed earlier in the cycle— a snack at +2 and perhaps +4 and not feeding as late as +6?
I think there’s too much movement in the dose. I think we need to follow SLGS protocol and pick a dose and stick with it for 7 days unless he drops below 90, when we would reduce. Would you object to that and would you object to posting here for help? And can you test more and earlier in the cycle so we can track Avery’s travels? Tell me if you are away from home due to work.
@Suzanne & Darcy I'm SOOOO sorry I haven't responded. I waited for an email to notify me of a response but I missed it while at work. I'll check here manually more often and bookmarked this message board so I don't miss a response. Again I apologize to leaving you ignored for he past few days. I 100% agree with you and wish I read your message earlier. He read as "LO" today so you were probably correct about his dosing. I gave him a 2.5u this morning which was his usual but dropped very low. I think we'll drop him to 2u for the next week and I'll come back with info. Also, yes we can feed at +3 instead of +6 and will attempt to test every 2 hours or so.
That’s a good idea. If you can try to hold the dose even when he looks high. We can really see what he’s doing on 2 units. Also, yes, feeding multiple small amounts early in the cycle before about +6 (like at +2 and +4.). The reason I am a fan of the +2 snack is that, for a lot of cats, the ProZinc starts to kick in about +2. So the small meals/snacks can really help stabilize the cycle. I don’t skip the snacks even when they’re bouncing as it’s not going to impact BG much if it’s low carb food and it’s good to keep up the cat’s routine.)
Thankfully you caught that Lo!! And I am sure you gave high carb food and/or karo syrup to bring the BG up? And then you have to keep testing every 20-30 minutes until the numbers are rising and feed more HC if they aren’t.
I think if you want to receive an email notification when someone comments on your thread, you need to touch on your account name (Cheshire Kitten) and there’s a menu that drops down with two columns. If you select “Preferences” you can set it to receive emails.
@Suzanne & Darcy Yep we're going to use 2u and see how he does on that after a week or two. The 2.5's have ended up in a hypo episode at least once a month since 2024. Yes, luckily my fiance was home and used 2 strips to confirm the "LO" reading. We have a hypo kit ready and used Fancy Feast gravy or one of the "touch of milk" ones he really likes. Re-tested and he jumped to the 200's. I'm off on Monday and can probably test him more regularly during the beginning of the week then I head back to the office. We're also going to take your recommendation and feed him at +3.
@Suzanne & Darcy By the way I just want to thank you again, you're always so responsive, patient and helpful.
Sounds good. 7days should be long enough for us to see what is happening (per the start low go slow protocol). But if it looks like we need another day or two, we will wait. Thanks for letting me know. Good luck. Some people use automatic feeders to dispense small snacks at various points in the cycle (while they’re at work.). It’s great that there is more than one of you who can test Avery!
@Suzanne & Darcy 593 this morning but dropped later. Our pack of lancets and strips are out for delivery now so we'll have enough stock to run more tests. I'm moving their feeding time up an hour each day so +5 today, +4 tomorrow etc...
UPDATE: Hit a nice number last night at +5 (160) however he's regularly testing over 300 - we're lucky to see anything under 300. Pre-shot BG are higher than I'm used to but I've been sticking to the 2u. We've moved up his snack to +3 and feeding him slightly less per day. He's getting 5.5 oz Weruva BFF chicken divided in two during shots; half a brick of dehydrated freeze dried food twice a day and freeze dried salmon treats. We did little skin tests and he felt very slightly dehydrated compared to my other cat. Also noticed he's drinking a little bit more water than beforehand. Overall, the 2u is bringing him 50% down from his pre-shots but his consistently elevated levels are still concerning.
You are doing great. Can you hold onto this dose for a full 14 cycles? I’m encouraged to see the blue nadirs. It’s not every cycle and I do think that we will increase to 2.25 soon, but I would like to stabilize things for a few more cycles. I know how hard it is for you when you do see the higher (ugly) numbers.
@Suzanne & Darcy That's the plan. My fiance has insisted to hold for a full 7-8 days as well. In the past I'd often lose resolve after a few high BG readings but I'm gonna hold on. I do suspect a 2.25 is on the table but wow, the difference between 2.5u and 2u is so massive. Anyway, I won't be able to test tomorrow since we're both in the office but we'll continue to monitor as often as we can. I'm glad I tested before going to bed last night, otherwise I would have missed the 160 reading.
It’s great to see those blues. That shows that you can have a good response to the insulin. Good for your fiancée! It’s good to have support when you are wavering.
@Suzanne & Darcy Hey Suzanne, we've brought it up to 2.25u but the month has been horrid. Not a single green number (that we know of) in weeks. Any advice?
@Suzanne & Darcy Yep, already raised him to 2.5u last night. I can definitely hold this as it was his previous dose. The issue is that he went hypo on 2.5u before so we were concerned and thought maybe he needed a decrease. However, I was also dose-surfing before so I'll remain consistent.
Hi there. Cat’s insulin needs can and do change over time. Also, that 47 (and the other limes) could have occurred for a lot of reasons including not getting snacks during the early portion of the cycle (+2, +4, etc.) … not enough food overall in that day? Cat off his food? So the thing to do was drop Avery down by .25 units and then hold the dose for 7 days (except if BG drops too low.). After those 14 cycles are complete, you look at the overall numbers and especially the nadirs and see if you need to hold, increase or increase. Is he getting the small low carb snacks spread out before +6? Even at night? Even if his numbers are high?
What does he eat? Sorry for asking this again. I can’t tell from your signature as it just says combo.
Okay so: Meals are Weruva BFF (Topsy Turvy & Take a Chance) alternating. So one day we feed Topsy Turvy, another we feed Take a Chance. The cans are 5.5oz and we feed him half of that in the AM and PM (before shot) so 2.75 oz. He eats ALL of it - I have to make sure he does because his sister will eat whatever he leaves behind and throw up. Before your suggestion moving to +3, we fed at +6 during the day. We gave him Vital Essentials Freeze Dried Raw Cat Food, Chicken Mini-Pate, rehydrated with a generous amount of water. They're about 2in x 2in and we break them in half. Those are his snacks (now at +3) but at +6. He loves this stuff and eats all of it. 09AM - 2.75oz of Weruva BFF 3PM - half a brick of freeze dried raw food rehydrated (now at 12PM) 09PM - 2.75oz of Weruva BFF 12AM - half a brick of freeze dried raw food rehydrated 02AM - half a brick of freeze dried raw food rehydrated (just in case). He weighs about 10.5 lbs at the moment. Doesn't appear to be losing weight, not dehydrated and still cuddly.
Okay. That’s all good food. I feed the Weruva BFF flavors that you do. Isn’t there a noon snack in there above? Between 9 a.m. and 3 p.m. ? I just didn’t see it so I was wondering.
Okay. I understand. Sorry He can eat both at +3 and +6. It’s okay. But definitely +2 or 3 is not to be skipped
@Suzanne & Darcy No worries! Yeah we give treats after he gets tested so he's been getting an extra snack at +6 too. Hopefully the shift back to 2.5u provides better results. Historically it was a pretty neutral dose and we'd see a fair amount of green numbers. He also does very well at 2.75u but I don't think it was sustainable since he'd often border very low.
@Suzanne & Darcy Hey Suzanne. We've been holding Avery at his usual dose - 2.5u. We got a few green numbers but we're seeing higher levels across the board. Heis BG is regularly over 200, sometimes 300 throughout the day. We're growing very concerned since his BG is extremely erratic. Additionally, 2.5u was also the dose where he got the "LO" reading a month ago so there's also a concern of raising him. I'm at a loss as to what could be causing this. I'm even considering user errors so I'll run a few by you: 1. I tend to inject him around the same location. I'm wondering if changing the injection site is a viable option. I may try to inject him lower down his back and closer to his side then between his shoulder blades. 2. We store the insulin in the fridge, roll the vial and use the syringe to draw 2.5u. We do keep the insulin vial by the door which is prone to open/closing and we've noticed in the past that when we get down to about 1/5 of the bottle, his numbers begin to become erratic. 3. I'm generally good about administering the shot. I tend to feel the needle move through his skin smoothly and without a second layer of resistance. I check to ensure the needle didn't puncture through the other side of his skin. Then I check to make sure there are no wet spots where the insulin could have hit. I'm not sure what else to consider. I'm going to try the new injection site tomorrow but I may up the dose to 2.75 for 6 cycles and then 3u if the results aren't good. Otherwise his behavior appears perfectly normal. I'm just not sure what else we're supposed to do. We're also considering changing from ProZinc to Lantus but I'm not even sure that'll make a difference. His diabetes is extraordinarily aggressive despite our best efforts to keep him well regulated. The way it looks, his body absorbs the insulin rapidly and later in the 12 hour cycle. Then he immediately has a bounce to counter the rapid drop in BG. That's my theory anyway. Today it was like we didn't give him a shot since nearly all his readings were over 300, many over 400. Any suggestion are appreciated. Thanks.
Some people inject into the flank. Just be careful that you have enough skin there to inject under the skin only and not into a muscle. Have you seen this -- testing and shooting tips -- it has pictures of different injection sites and also describes the "roll method" for shooting that some people find helpful. https://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/
You may want to try a new vial of ProZinc. Are you down to 1/5 of a vial? It's true that the door isn't the coolest place. I bought a digital thermometer and it hung right over my insulin in the fridge.
Just because he had a lime green before on this dose doesn't necessarily mean he will have another one. And that day he may just not have eaten snacks at enough different times or eaten enough, etc. (see your post #27 above... I don't think he was getting fed snacks at the appropriate time when he had the low reading.) Cats' insulin needs do change and don't always stay the same. I'm so sorry that he's having the frustrating numbers. I would not hold doses for too long, that's very important. I would switch to the Modified ProZinc method and adjust his doses (when required) every 6 cycles. He doesn't eat dry food, so you can do MPM. Right now it looks like he does need more insulin though, so an increase of .25 is in order -- and keep up with the couple of snacks before +6 (3 p.m.)
I see you already got a blue number today with the increase. That's good. Hold that for 6 cycles. Then let's see. Okay? This is an example of a day where a +2 snack would be beneficial. I don't know where he was at +2, but if he dropped 100 in any one of those early hours, then that will set off a bounce. I hope not anyway. It may have been a good steady drop (hope so.) Also, recently, we don't have any idea what he's doing in the latter portion of the cycle. I don't know if your schedules can swing it, but seeing what happens at +8 and +10 could help us to see if he's getting good duration.
Hey. You disappeared on me I’m checking in on him again this morning. I’m encouraged by the better numbers. How about you?
Hey @Suzanne & Darcy LOL NO I'M STILL HEEERE! Apologies, Wednesday we had heavy rain so I was concerned over flooding and Thursdays is the day both my fiance and I go in to the office so we're not home all day (that's also why you wont see any readings on my sheet, those are Thursdays!).We work as therapists so our schedules can be booked back-to-back with clients throughout the day. Okay so the vial seems fine! I bumped him up to 2.75u and yeah, numbers are looking better now. It sucks that I couldn't test him today but I should be okay for the remainder of the week. I did see your message and began to read on the MPM method instead which (based on how you described it) sounds better than trying to hold him on a single dose. I think I will switch because he's too erratic to hold at the same dose for longer than a week or so. Also I began to shoot him lower and toward the side instead of on his back (where I've been shooting him since last Oct) and I don't know if that has made a difference but I'm just going to stick with whatever been working. Sorry for venting the other day, I was honestly a bit emotional when I was writing that. You've been superb at just checking in honestly, literally a saint so thank you. Oh and regarding the snacks, yes we've been doing +3 for snack time instead of +6. We're still adjusting since we begin working at that time so we can get a bit forgetful (that's why we fed at +4 Wed) but we think we can maintain it based on our schedule. Anyway game plan: 1. Switch to MPM method. 2. Continue to feed what we've been feeding and stick to snacks earlier in the cycle +3. 3. Maintain 2.75u for 6 cycles and do not hold for too long. Looking back the 2.5u was held for way longer than necessary. 4. Test later to get the full scope of his curve so maybe testing at +3, +6, +9? We generally feed a freeze-dried treat when we test as well, he's associated the testing with being fed in some way. It's made him super cooperative to test but also very demanding for feed afterward lol. Am I missing anything?
I agree with 1-4 above. You’ve got this! Don’t worry about venting! It’s good to have a place to vent frustrations periodically. We understand that here for sure!
Yeah, there was a bounce today but it was expected. I'm holding the 2.75u for the time being. Really glad to see he's responding a little bit more predictably on this dosage.
So am I! Next time if you get something as low as a 53 at +5 I would give a snack and keep testing to make sure he’s not dropping further. Since this was at night, you probably would need to set an alarm to wake up and test.
I keep forgetting to test later in the cycle! I keep telling myself but end up doing other things and before I know it, it's time for the PM shot. I'll try to get one over the next few days at like +9. We found some great snacks for him by ZIWI Peak air dried beef which seems to have a super low carb % so we can use those pellets as treats if he tests around the 50's or lower. Last night I actually switched to 2.5 and plan to hold that for another day or two before going back up to 2.75u via MPM. I'm still reading the main thread on how it works but it sounds like just holding the dose for a bit, then changing based on NADIR and general insulin to curve efficacy more often.
@Marje and Gracie do you have any suggestions on Avery’s dosing and his spreadsheet. I think he was starting to see better numbers on the 2.75 dose
I think dose hopping isn’t helping If you are doing MPM, you should hold the 2.75u six cycles minimum unless Avery eats a reduction. If he’s getting into blue BGs, hold ten cycles but if he’s not, increase by 0.25u.
@Marje and Gracie @Suzanne & Darcy Thank you both for helping. The issue we run in to with 2.75u is that we begin to get blue readings late in to the cycle. I'm apprehensive to hold it but I suppose I can always skip a dose if his pre-shot BG are in the low 100's? I'm unsure. We moved him back to 2.5u and we're seeing more greens and blue numbers but it does look as if he's bouncing in the AM.
I don’t see any tests in the last several weeks that verify this statement. Usually, you wouldn’t see the BG dropping off late in the cycle (+8 to +10 etc) unless a bounce is clearing. And there is no reason, at this point, even under SLGS, for you to skip a shot with a BG above 90. With the low number last night, under SLGS, you had to reduce today which is a good call on your part. If you are able to get him completely off dry food, slowly, you can do MPM and make adjustments sooner that would help his progress.
@Marje and Gracie Actually you're correct. The 2.75u seemed potent back in Jan. when I was dose surfing more often. Thanks for correcting me, the 2.75u is still on the table. I've changed my sheet back to SLGS since I'm not committed to the MPM yet. Currently, the only dry food he is eating are freeze dried with less than 10% carbs (Ziwi Peak Chicken, I believe) and we're feeding him Weruva BFF which is also less than 10% carbs; he doesn't get conventional kibble and hasn't since he was diagnosed. The 2.5u is where what we've mostly given him and have had a good amount of green numbers. There were, however, two incidences where he had hypo episodes: March 02 and Jan. 07, so we get spooked that the 2.5u was too high, tried to bring him down to 2.25u/2u but failed to get consistent green NADIRs. Suzanne theorized it could have been because he wasn't getting enough snacks, or perhaps some other variable I haven't accounted for. I suppose since the 2.5u yields better results, should we just stay there and stick to the SLGS? You're right in that I don't want to be dose surfing and shooting based on pre-shot numbers and what I think his NADIR will be. Also, your comment about skipping for anything over 90 is noted, we'll still to it; luckily we work from home so, for the most part, we can monitor him. I definitely think his sweet spot is somewhere between 2.5u and 2.75u but I can hold the 2.5u dose and follow SLGS. Is that a sound plan or do you suspect he'd do better at 2.75?
Under SLGS, Avery has actually earned a reduction to 2.25u with those drops below 90. This is why I believe it’s best to get a cat off dry food because I am certain 2.25u is not going to be a good dose for him. However, under SLGS, you should reduce for a week and then reassess. It has always seemed to me SLGS can really slow progress in many cats. I’ve looked at the ZP freeze dried food and scratched my head over whether it is “dry” like kibble foods. We’ve never classified freeze dried the same as kibble. But it sounds like the Weruva is kibble?
Hey @Marje and Gracie, so quick update - I bumped him up to 2.75u recently and his numbers have been way better. It's only been twice though and last night I gave him 2.5u out of habit. I really hope these numbers don't begin to drop him too low after a few days. We tried 2.25u for 5 days and the results weren't ideal. With 2.5u we had some good numbers but more often than not, he was over 300. We held him at 2.5u for over a week, so that's why I started to reconsider an increase to 2.75u. One issue we encounter is that we'll find a dose that appears good early on and after a few days he begins to drop very low. Afterward we attempt to reduce his dose and don't get green numbers. Anyway, the Ziwi Peak is advertised as "air-dried" and here is the nutritional info: Crude Protein (min) 38.0% Crude Fat (min) 30.0% Crude Fiber (max) 3.0% Moisture (max) 14.0% Ash (max) 12.0% Taurine (min) 0.23% Chondroitin Sulfate (min) 3000 mg/kg Glucosamine (min) 1000 mg/kg Calorie Content (calculated) 5000 kcal ME / kg Calorie Content (calculated) 474 kcal ME / level cup Now, I'm not 100% but wouldn't this suggest low carb? Please let me know if I'm incorrect here. Regarding the Weruva, they're canned wet food with (I believe) less than 10% carbs. The brand name is Weruva BFF and the flavors are both chicken (Topsy Turvy & Take a Chance). We feed him one 5.5oz can, alongside his snacks throughout the day. Here is the info: https://www.weruva.com/pages/cat-nutritional-information You have to find BFF Play Pate and "view" nutritional info. So if I'm not mistaken, his diet is less than 10% carbs t the moment. If the Ziwi Peak is not low carb as I originally thought, I will stop feeding him. However the Ziwi Peak was only added recently (within the past week) because we couldn't find his freeze dried bricks anywhere.
I feed those same two flavors pf the Weruva BFF pates (very moist wet food) to my cats and they’re both 5.2 percent carbs. They’re also kidney friendly because of the lower phosphorus. Here is a list I have of all Weruva foods. Protein, fat, phosphorus, carbs, etc. https://www.bizave.com/foodlists/Weruva Low Phosphorus.pdf
I didn’t think that the Ziwi Peak freeze dried food was considered kibble. It’s like Pure Bites freeze dried meat, isn’t it? Anyway, I think you still would be able to do MPM. Just because it allows dose increases to be made every six cycles doesn’t mean that you necessarily would do so every time. It’s just better for the cat, in many instances, to not hold doses for seven days. I frequently see ProZinc kitties whose progress is being stalled when following SLGS.
In order to determine the % calories from carbs, protein, or fat, you have to get the as-feds or dry matter basis values from the manufacturer. Then you could calculate it by using the info in this post. I agree with Suzanne the ZP does not appear to be dry food. Our two methods of regulation are there for a purpose: safety. Dosing isn’t done by the caregiver just deciding their cat’s BG “looks better” At a specific dose so that’s what they choose to shoot. Because you were doing SLGS, I advised you Avery had earned a reduction from 2.5u to 2.25u. You chose, instead, to raise the dose. My best advice is to decide which method you will use and then stick to it as it is written.
@Marje and Gracie & @Suzanne & Darcy Sheet updated to "MPM", should have updated days ago. I've read and re-read the thread here; alongside the ProZinc Dosing Method sticky. Based on notion that SLGS can begin to stall progress and that he's already adjusted to low-carb and no dry kibble. We can provide multiple small meals throughout the day while testing at +3, +6, and +9. Will stick to it as written as to avoid avoidable hypo episodes. Under this method, if nadir go anywhere under 50 then reduce dose, if 50-100 hold for more cycles and if 100-200 then increase 2.25. In regard to reductions, we'll reference the last good (or in this case safe) dose which appears to be 2.25 and will report back.
