Beauty's dosing thread

Erin & Beauty

Erin & Beauty

Member Since 2020
Beauty's pre-shot numbers are trending in the right direction, which is wonderful, but I anticipate needing some help/feedback, so I figured I start a thread for her.

She was at 191 for her AMPS this morning. I figured this was close enough to 200 to be within the glucometer's margin of error, but I did reduce the dose from 0.75 to 0.5 to be on the safe side. Although, she was fine at PMPS of 213 last night with 0.75 units (was at 149 +4), so maybe 0.75 would have been fine? Better safe than sorry I suppose. I'm going to telework today so I can see how she responds.

Also, she didn't pee on the floor overnight! Yayyyy! She has been peeing outside the box for the past few weeks.
 
Erin & Beauty said:
I figured this was close enough to 200 to be within the glucometer's margin of error, but I did reduce the dose from 0.75 to 0.5 to be on the safe side.
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And you seemed to have had the right idea, beautiful cycle today! :) Hope she stays low for you at PMPS!
Hooray Beauty, that's a great sign!
 
Oh my...165 at PMPS. I gave 0.2 units (0.5 mark on U-100 syringe). I'm happy she's improving but it's a little nerve-wracking for me seeing low numbers!
 
Is Beauty only eating the Fancy Feast pate food now? I mean, except for when you are trying to bring her low numbers up with greenies or Lean Treats.

The Lean Treats for Cats do have a bit of flour type ingredients in them, so that should bring up the BG levels. Or you could try a teaspoon of her regular low carb food.

She did earn another dose reduction. Sometimes the food change to lower carb food can make a big difference in the need for insulin. Looks like Beauty may be one of those cats.

Following the SLGS dosing method, your pre-shot can be 150 and you could still shoot the full dose of insulin. With time and test data, you can lower that pre-shot threshold.
If it's lower than that threshold number, stall without feeding and test again in about 20 minutes, looking for a rising number, 20% or so higher. Not just a few points different, as that could be meter variance from 1 test to the next. I would not recommend stalling for more than 1 hour, as that throws off your shot schedule and leaves the cat very hungry.

With the U100 syringe, you can measure even smaller doses, like the 0.25U dose.
So that may be Beauty's next dose, if she drops again < 90 mg/dL.

There are only 2 smaller doses you can give with a regular U40 syringe. (You can measure these with a U100 syringe too.)
"Some" insulin, where the bottom of the plunger is barely above the first line on the syringe, what we think of as the "zero" mark.
A "drop" of insulin, where you only give 1 drop.
Takes practice with some colored water or liquid and an used syringe to get that one drop.
So practice, practice, practice.
 
She is almost exclusively on the Fancy Feast pate now. She takes her hyperthyroid pill twice a day in half a pill pocket which I know has carbs, and I give her freeze dried chicken treats when I test her. I have a few kibbles out, but have not added any more to the bowl in a couple of days. She has eaten maybe a few a day - prefers the pate which is right beside the kibbles. I am thinking I will remove the kibbles entirely now.

For 0.25 on the U-100 syringe, just go a smidge past the 0.5 mark?
 
Freeze dried chicken treats are fine.
Erin & Beauty said:
For 0.25 on the U-100 syringe, just go a smidge past the 0.5 mark?
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That would be be about halfway between the 0.5U mark and the 0 (zero) mark on the U100 syringe. Closer to the plunger end. So a smidge below the 0.5, not that far up the insulin barrel. Picture, copied from the Sticky. This Sticky>>>>>>
Sticky INSULIN CARE AND SYRINGE INFO Proper Handling and Drawing
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Erin & Beauty said:
I am thinking I will remove the kibbles entirely now.
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She might drop even more BG level wise, when you remove the last of the dry kibble. So keep a close eye on her behavior and test if she seems "off" in any way.
 

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I had to stall this morning. She was at 131, then 146. I gave 0.1 U as she got down to 90 at +4 last night and 0.2 makes me nervous given the low AMPS. I will be home to monitor her today so we'll see what happens!
 
A good day for Beauty today, so far. APMS was 131. I gave 0.1 unit and she got to 82 at +2.75. PMPS was 128 and I gave "some" and will monitor her this evening.

Am I being too aggressive shooting at the low PS numbers? I would definitely not be taking this approach if I could not monitor her. Any recommendation for a "definitely do not shoot" PS number?
 
Erin & Beauty said:
Am I being too aggressive shooting at the low PS numbers? I would definitely not be taking this approach if I could not monitor her. Any recommendation for a "definitely do not shoot" PS number?
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As long as you can monitor her, and know how to bring up the low BG levels with LC, MC, HC food and or a simple sugar like honey or corn syrup, shooting the low numbers is ok.

I would not recommend shooting any number < 90 mg/dL. Not until you know how well Beauty responds to the carb content in the food. Since you only took her off the kibble a couple of days ago, that experience on how she reacts to the carb content of the food will take a bit of testing and trial and error. Even then, you need to be around to test every 20-30 minutes if she drops <50 mg/dL.

Kibble takes longer to digest, so it's why reaching first for the wet food when the BG levels are low is the better idea. Any dry food has to get broken down in the stomach first, and takes time to get into the bloodstream. So try to avoid the kibble and treats like the Temptations when you are trying to bring the BG levels back to a safe level.

Here is something I wrote up some time ago about drop dosing. Hope it helps you.

Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.
  • Practice, practice, practice to see how many drops you can get out of the syringe.
  • Use some sort of colored clear juice like apple juice or colored water.
  • Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
  • Draw the "test liquid" up to the first line on the syringe.
  • After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. To move/push the air bubbles to the top of the syringe. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the “test liquid.”
  • Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
  • You are looking for consistency.
  • Try to get evenly sized drops.
  • Practice, practice, practice until you get a consistent number of drops.
Do you think you have the technique down for the drop dose?

Then let me know.

When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.
Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick”. To move/push the air bubbles to the top of the syringe.
  • Push out the air bubbles that have floated to the top.
  • Slowly “twist” the syringe plunger to push out all the insulin.
  • Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
"Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops.

Be aware that some syringes can vary on where the lines are on the barrel.
 
Thank you, Deb! I truly appreciate all of your help. I have no idea what I would have done if I hadn't found this place! I can't imagine my vet coaching people on giving a drop or two of insulin.

AMPS was basically the same as it has been the past couple of days (132 mg/dL) and I gave her insulin at the zero mark on the syringe - estimate 2 drops, if the mark was the same on the practice syringe I have been using.

I know I've already gone off the rails a little bit with SLGS due to how well Beauty is responding to the diet changes and insulin. Is there a point where you'd recommend moving to another method? Particularly with regard to the cutoff for reducing doses. She got into the 80 mg/dL range both cycles yesterday, and quite possibly on previous cycles too as it seems her nadir is earlier than I had caught before.
 
Usually you want at least a months worth of data before your decide the SLGS dosing method isn't working for you.
But I think it is working. I simply think that Beauty is earning dose reduction after dose reduction so you need to change the dose faster than the SLGS standard 1 week. But that is all part of SLGS, to take those reductions when the BG's drop below 90 mg/dL.

As you gather more data, it's perfectly ok to modify the SLGS guidelines to more specifically meet YOUR cats needs.
That's what you have been doing. It's what has given Beauty that "pep in her step" as your SS Remarks say for today!
 
I suppose it's a sign of Beauty's progress that 170 AMPS seemed high to me this morning! Despite the "high" AMPS number she got down to 86 at +3 on a "zero mark" dose. I reduced to a 1 drop dose this evening. I also started her on methyl B-12 today, mixed in half a tube of Tiki Cat Stix, which she was more than happy to eat.
 
No insulin for Beauty today. AMPS was 118 mg/dL and +3 was 91 mg/dL. PMPS was 107 mg/dL. I think that little pancreas is working!

If I do see higher PS numbers in the coming days, should I give her a drop?
 
Erin & Beauty said:
If I do see higher PS numbers in the coming days, should I give her a drop?
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Maybe. Depends on how high the pre-shot number is, and what the trend in the numbers has been for the past few cycles.

How are Beauty's other symptoms? The 5 P's (purring, preening, playing, pooping, peeing) and appetite are a nice easy to remember visual check on how she's doing.
 
I have seen quite a bit of improvement in Beauty's symptoms - most especially peeing. She had been peeing outside the litter box, but hasn't in the past few days. She's also not peeing the huge amounts she was before. She has some neuropathy in her hind legs which so far has not improved much if at all. I'm hoping the methyl B12 will help.

I was very happy to see 74 mg/dL at +3 this morning, with no shot!
 
Slow but steady progress.

Wink had neuropathy really bad. Wish I had taken video to show how bad it was. But I never thought to do that. He could barely walk 4-5 steps without having to stop.
It takes time for nerves to heal. Several months is common. But it can heal completely. It did with Wink.
That picture of him in my avatar is him up on the kitchen island breakfast bar. A chair to assist, and he got up there all by himself!
Then he started to eye the 6 foot bookcases, and the top of the fridge. This from a cat that had big trouble walking when I fostered him.

Getting the BG levels back to a normal range is a big part of helping with the neuropathy.

So every time you get a blue pre-shot, please get a +3 or +4 test if you are able to.
If that +3 and/or +4 is down in the green, it tells us the pancreas is working and producing it's own insulin. Counteracting the food intake.
So exactly what you want to see.

We focus too narrowly on the BG numbers sometimes. Ok, a lot of the time. But how your cats symptoms are improving is a part of the overall picture on how they are doing.
 
Just to share - We have gone from not standing up and no walking to standing up and taking some steps now that our BG values are so much better. Maybe the B12 is helping to accelerate, maybe not - but certainly seeing improvement in the past month. She made it to her box overnight once for a BM, hoping she does the same to pee soon! Baby steps
 
MelanieAndJosh said:
Just to share - We have gone from not standing up and no walking to standing up and taking some steps now that our BG values are so much better. Maybe the B12 is helping to accelerate, maybe not - but certainly seeing improvement in the past month. She made it to her box overnight once for a BM, hoping she does the same to pee soon! Baby steps
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That's great improvement! I peeked at Weenie's spreadsheet and I'm no expert but her numbers are looking great :)

Thankfully Beauty has still been able to walk, but she has to stop to rest sometimes. I feel bad because I had noticed her rear legs seemed weaker over the past few months, but I wasn't seeing any other diabetes symptoms and didn't know that could be a symptom. She's 18 so I figured it was just old age. I'm just so glad I found FDMB right after she was diagnosed, and that changing her diet had such a huge impact on her BG levels.
 
Erin & Beauty said:
That's great improvement! I peeked at Weenie's spreadsheet and I'm no expert but her numbers are looking great :)

Thankfully Beauty has still been able to walk, but she has to stop to rest sometimes. I feel bad because I had noticed her rear legs seemed weaker over the past few months, but I wasn't seeing any other diabetes symptoms and didn't know that could be a symptom. She's 18 so I figured it was just old age. I'm just so glad I found FDMB right after she was diagnosed, and that changing her diet had such a huge impact on her BG levels.
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Don't feel bad, the same thing happened here. First it was not realizing she was drinking more. We also saw that she would walk and then get tired and let that go too long. Working on it though!
 
Day 14 of the OTJ trial is complete, and I believe Beauty is officially OTJ! I have seen a lot of improvement, both in her BG numbers and in how she seems to be feeling, over the past two weeks. Thank you to all who have given advice during her brief time on insulin, especially to @Deb & Wink for reassuring me on following SLGS all the way down to an OTJ trial.
 
Fantastic Erin! You did all the real work to get Beauty to where she is. This is how Beauty is feeling.

OTJ day 14 cat diving thru waterfall.jpg


Here are some tips on how to keep her OTJ (off-the-juice, insulin being the juice).

Here are some tips to stay OTJ (off-the-juice, insulin being the juice)
1. Never feed dry - not even treats. (freeze dried is ok, Dr. Elsey's chicken flavor is ok.) If you change wet food types, be 100% sure the new food is also low carb and same low carb % as your current food. Some cats are very carb sensitive and an increase from 3-6% to 8-10% can spike the BG’s. Don’t feed if you aren’t sure!
2. Weigh every 2 weeks to 1 month to watch for weight changes. Too much of a weight gain can cause loss of remission. Too much of a weight loss alerts you to other issues, such as hyperthyroidism.
3. Measure blood once a week, indefinitely if possible. You want to catch a relapse quickly. Some people only do checks every 2 weeks to a month. BG checks can sometimes alert you to other issues.
4. No steroids or oral meds with sugar - remind your vet whenever giving you any medication. Always double check. (Steroids may be needed for other medical issues. But remind your vet your cat is a diabetic, diet controlled.)
5. Monitor food intake, peeing and drinking. If increasing, a sign of losing remission. Or another medical condition like Hyper-T or kidney disease.

6. Regular vet checks for infection such as dental , ear or UTI. And get them treated quickly!

7.Continue to ketone test even if your cat is OTJ. Ketones can develop if the cat’s pancreas is not producing enough insulin, or burning off too much fat if your cat is not eating properly and other reasons.

If your cat does fall out of remission you need to be more aggressive and resolve issues/ back on insulin as soon as possible as the window for a second remission is tight if any. Pancreatitis, hyperthyroid, dental issues are the most common reasons cats fall out of remission.

"Once a diabetic, always a diabetic." They are simply diet controlled.

p.s. Sorry the congratulations are so late, but the message board would not come up for me at all on Thursday 9/3/20.
 

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