charly - reduced dose

Oh that black is ugly. I would not have anticipated that. If she’s black tomorrow morning I think it will be okay to take her back up again as long as you can monitor the cycle as normal.
 
Things change so quickly

She's had two good cycles now. One am cycle at reduced dose of 2.25 and one pm cycle at 2 units after < 200 pmps

Both times I've fed her small amount of LC food two or three times around nadir to try and keep her out of lime green numbers.

It seems to have worked pretty well but she will never earn a reduction if I keep doing this.

Last night she went down as low as 56 even on just the 2 units.

Should we perhaps reduce her dose again to 2?
 
Let me take a look at what is going on today and the last few days. Usually, as long as you are only feeding low carb wet food, there is not a need to reduce the dose. It’s when you are having to use higher carbs (medium carb food or high carb food) to prop up the numbers that we recommend reducing. But let me look at Charly’s case specifically and give you my thoughts.
 
Ah great thank you.

Yes ive given her a tablespoon or two of about 5% carb food 2 or 3 times between +6 and +9 in both the last two cycles because I felt like she was likely to dip below 50 otherwise.

I've gone 2 units this because I'm not able to monitor so closely today, plus I'm feeling a bit tired after last two sessions and plus Charly is getting grumpy about having her ears pricked all the time!
 
Well, you reduced this morning anyway so it’s kind of a moot point. You can wait and see how she does on the 2 units. I probably would not reduce until she actually earned the reduction according to the protocol. I would try feeding her a little less of the food (probably a little less frequently for the latter part of the cycle or skip some of those later snacks just to see if she is able to keep her numbers above 50 on her own of not — I am not saying it’s wrong to give a teaspoon of LC food, just that she’s getting a lot of them and we can’t be sure if she really needs all of them (+7, 8, 9, etc). Also, she is still having very high preshot numbers a lot of the time and I am hoping that those are going to start to come down. It’s your call though. I’m not the one staying up all night with Charly, right? :) You are doing a brilliant job.
 
DavidJ said:
Ah great thank you.

Yes ive given her a tablespoon or two of about 5% carb food 2 or 3 times between +6 and +9 in both the last two cycles because I felt like she was likely to dip below 50 otherwise.

I've gone 2 units this because I'm not able to monitor so closely today, plus I'm feeling a bit tired after last two sessions and plus Charly is getting grumpy about having her ears pricked all the time!
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I totally understand! Hopefully she will still have some good greens today even with the reduced dose. It looks like she is on track to do so. I noticed her ketones were at .9 when she was in the reds so that is also a consideration, but she went down later in the cycle so I felt a bit better about things when I saw that.
 
Suzanne & Darcy said:
I would try feeding her a little less of the food (probably a little less frequently for the latter part of the cycle or skip some of those later snacks just to see if she is able to keep her numbers above 50 on her own of not
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ha. I thought you would say that! I kind of know thats what i should be doing but i'm still feeling my way towards being brave enough to wait and see when she's hovering just above 50 especially in the early hours of the morning.

I think charly and I both just need a little break from the drama today. we will see how she gets on and then when / if we increase I will try to intervene a little less next time!
 
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DavidJ said:
I kind of know thats what i should be doing but i'm still feeling my way towards being brave enough to wait and see when she's hovering just above 50 especially in the early hours of the morning.
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i thnk part of my worry is that when shes already dropped from (for example) 470 to 56 as she did yesterday in the am cycle, it doesn't feel very safe at 56 just 6 points above the hypo zone. It feels like the next reading could be practically zero. But I'm guessing there must be some resistance of some kind and numbers are less likely to fall so dramatically as they get lower?
 
Yes. A lot of non-diabetic cats will test in the 40s and they’re perfectly fine, but of course they’re not on insulin! So we don’t like to see them go below 50 for safety. The rate of drop certainly isn’t going to be the same unless a cat were heavily overdosed. I am not saying to just walk away and not test if she’s that close to 50. If she’s in the 50s and you would like to see how things go without the food (especially if she’s already had a few spoons the last hour or two) then just stick around and test her in 30 minutes. If she’s drops below 50 then naturally you would give food. If not then you can continue to see how it goes without the extra food. This is the only way we can learn her patterns.

I understand about it being nighttime too. Sometimes you have to actually hijack a cycle because you just can’t go on any longer (and even then, if you give HC you are still supposed to test for two hours after the HC was given to make sure the numbers don’t drop back down.)

It sounds like you and Charly both need a break!
 
Suzanne & Darcy said:
Yes. A lot of non-diabetic cats will test in the 40s and they’re perfectly fine, but of course they’re not on insulin! So we don’t like to see them go below 50 for safety. The rate of drop certainly isn’t going to be the same unless a cat were heavily overdosed. I am not saying to just walk away and not test if she’s that close to 50. If she’s in the 50s and you would like to see how things go without the food (especially if she’s already had a few spoons the last hour or two) then just stick around and test her in 30 minutes. If she’s drops below 50 then naturally you would give food. If not then you can continue to see how it goes without the extra food. This is the only way we can learn her patterns.
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ok, got it. that sounds doable. we will try that next time.
 
somethig strange going on this afternoon. very feisty about testing. so i gave up and let her be initially. a few minutes later she vomitted a little. i had another go at testing which was not at all easy and she was very unhappy about. i was expecting a low reading given that we are at the time she has been reaching nadir lately. but she is red.
 
i've kept her at 2units for tonight. I hope i've done right.
I haven't increased because I'm thinking it looks like she probably has bounced of a low that I missed around nadir.
I haven't decreased because a) I don't know for sure that shes gone low and b)i'm concerned about ketones.
So I have kept the same and I will keep an eye on her and try to steer with food if she looks to be dropping low. Hopefully she will let me test.
 
It doesn’t look like she had a low last night— even with the limited data, but who knows what happened after +5. She would have had to drop a long way on only 2 units, and I just doubt it happened. I think that she usually has a couple of days of good nadirs and it seems to take her a couple of cycles to get a decent bounce going… and then after about 2 cycles she gets back to work in the lower numbers. She may be on track to break the bounce tonight, but if not then almost certainly tomorrow. If she still has bad numbers after that, I would consider increasing back up.

Her ketones have been low. Good! Is she feisty because she feels well? Or because she doesn’t feel well? Or because she thinks you should be feeding her tastier treats at testing time? ;)
 
fesity because she is feeling good is my suspicion. she's always been a feisty little cat when shes healthy. shes very sweet but you have to be careful playing with her - she draws blood! and she bullies her big sister despite being much the smaller of the two.

the am cycle yesterday (28 feb) sometime between +7 and +10 is when I'm thinking she might have gone very low. she'd been low green the previous two cycles at that time and i'd been feeding her snacks if you recall.

but yesterday i reduced her to 2 and i was in bed asleep catching up on the sleep i'd missed at nadir time thinking i had a day off the cat drama. I'm pretty sure Charly was feeling very well at that point because she was sleeping under the duvet with me. This felt like a major milestone cos she always used to sleep there but hasn't done it once since diagnosis until yesterday. so we were both sleeping happily at nadir time.

then she woke up and jumped out of bed so i though may as well test her. but she was very very fesity about and wouldnt let me. so i gave up. and then she vomited so i thought omg i really better test her in case she's low again. but she was red. and she seems to have been high ever since.

good news as you say is that ketones have been low so far during the bounce. and she is eating well and generally seems pretty comfortable which hasn't always been the case in previous bounces. she has vomited twice now though which she has rarely done before so that's a little bit worrying.
 
Will she allow you to trim her nails?
She would have really have to have dropped a lot from +7 and gone up very quickly after that. She was higher at +7 yesterday than she had been the dat before. Who knows.
 
Yes she's usually okish with having her nails trimmed. Two or three at a time. over a few sessions. With treats.

But she's much more compliant again today so far.
 
Suzanne & Darcy said:
She may be on track to break the bounce tonight, but if not then almost certainly tomorrow.
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I was expecting it! ;). That’s what I wrote yesterday.

Now if she would only not bounce. If she’s true to form then she will have another decent cycle tonight and then tomorrow a.m. cycle could go either way… and after that the bounce. But let’s hope her body is acclimating to the greens and she will stop with the high numbers. It’s okay, Charly girl. :bighug:
 
Suzanne & Darcy said:
I was expecting it! ;). That’s what I wrote yesterday.

Now if she would only not bounce. If she’s true to form then she will have another decent cycle tonight and then tomorrow a.m. cycle could go either way… and after that the bounce. But let’s hope her body is acclimating to the greens and she will stop with the high numbers. It’s okay, Charly girl. :bighug:
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yes i know we were hoping / expecting her to break the bounce today. but shes never been green at +4 before. And recent nadirs have been as late as +9 :nailbiting:
 
And sadly, I see she went into red at PMPS. That was quick. She doesn’t want us to know what she’s doing (she’s the boss!)
 
Shes not being very co operative again with testing either.

It all feels a bit tricky at the moment. Seems like we maybe need to increase again? but nadirs at 2 current dose are already quite low. So an increase probably means more testing. And the more time she spends in green the more she seems to hate it!
 
DavidJ said:
Shes not being very co operative again with testing either.

It all feels a bit tricky at the moment. Seems like we maybe need to increase again? but nadirs at 2 current dose are already quite low. So an increase probably means more testing. And the more time she spends in green the more she seems to hate it!
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It’s not uncommon for cats who are new to green numbers to behave oddly. Some will hide under beds or other furniture and be very unhappy because they feel uncomfortable in green. In Charly’s case, though, I thought she was acting happy and active in normal green numbers. I hope it doesn’t mean she has other things going on— like the possible discomfort from pancreatitis. You would know best about when and why she gets feisty.
 
So…. Bottom line is that I would hold her at 2 units a bit longer. She did have green today — higher green but still green — so I think it’s all right to hold this 2 unit dose a little longer. Hopefully she will let you test and she will not stay in a bounce too long. This whole process can be so long and frustrating. We all hate seeing our kitties feel uncomfortable or get irritated with us.
 
Yes sorry, I wasn't very clear. It's the testing she doesn't like not being in green. She deffo feels better in green. Less compliant and more feisty is more her normal behaviour.

I had very much the same experience few years ago with her when I had to give a longish course of antibiotics - a tablet every day for a good few weeks. The first couple of weeks while she was poorly were easy. It was getting very difficult by the end.
 
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DavidJ said:
Yes sorry, I wasn't very clear. It's the testing she doesn't like not being in green. She deffo feels better in green. Less compliant and more feisty is more her normal behaviour.

I had very much the same experience few years ago with her when I had to give a longish course of antibiotics - a tablet every day for a good few weeks. The first couple of weeks while she was poorly were easy. It was getting very difficult by the end.
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I understand that. You just have to bribe her if she will let you. Have you ever tried small bites of ham for a treat? Some ham has sugar though— so not that kind. There are these little freeze dried shrimp that some cats like.
 
DavidJ said:
Yes sorry, I wasn't very clear. It's the testing she doesn't like not being in green. She deffo feels better in green. Less compliant and more feisty is more her normal behaviour.

I had very much the same experience few years ago with her when I had to give a longish course of antibiotics - a tablet every day for a good few weeks. The first couple of weeks while she was poorly were easy. It was getting very difficult by the end.
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I just meant that the bounces are very frustrating (to us the humans!) :)
 
Suzanne & Darcy said:
I understand that. You just have to bribe her if she will let you. Have you ever tried small bites of ham for a treat? Some ham has sugar though— so not that kind. There are these little freeze dried shrimp that some cats like.
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Yes im going to need some new tricks. The old ones aren't working at the moment . She's been getting freeze dried chicken treats after tests but they don't seem to be impressing her any more.

We seem to be moving into a new stage of treating a cat who doesn't feel so ill any more. She's regaining more normal behaviours again the last day or two.
 
she's had a great couple of days , looking much much more like her old self. but shes back in black today and looking a bit sorry for herself again. hopefully she will come back down soon.
 
DavidJ said:
Yes she's started the day in yellow today
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and spent quite a long time in green. She dipped below 50 a couple of times. So I think that means she has earned another reduction?

But at the moment it looks like her pmps might be quite low.

does this look ok for this evening?
190 or above — give full dose (ie 1.75 now with todays earned reduction)
150-190 — give 1.25 - 1.5 units
100 - 149 — give 1 unit
Below 100 skip shot.
 
I’m just seeing this. What did you shoot. She had gone up quite a bit from earlier in the day. I hope she won’t bounce too high.
 
Suzanne & Darcy said:
And congratulations on the reduction to 1.75 units.
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its a good thing? I wasn't entirely sure. I've read here some folk talking about feeding to avoid drops the earn reductions so I was wondering if maybe it would be better to try and hold the dose at least while her pre shots seem to be regularly red and black....?
 
I understand, I probably would have shot 1.25 to 1.5 because of her rising numbers. But it will be a good time to see how the 1 unit works so you can use that information for a similar situation in the future. I am actually encouraged that she earned a reduction today!
 
DavidJ said:
its a good thing? I wasn't entirely sure. I've read here some folk talking about feeding to avoid drops the earn reductions so I was wondering if maybe it would be better to try and hold the dose at least while her pre shots seem to be regularly red and black....?
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I think it’s a good thing. The way feeding to prevent a reduction works is when a cat is approaching 50, you would give higher carb food to keep them from dropping below 50 in order to hold the dose a little longer. It doesn’t always work. Charly earned it today and we should let her have it. I think she’s still going to bounce, but her bounces have been clearing faster.
 
Does Charly have any other surprises for us today? I see she’s been a fussy eater today. Is Nature Menu a new food for her?
 
she seemed fairly comfortable through the night even when she was in red. but by amps she was black and not looking very happy. she quite often refuses the katkin when shes in black. today she was not very keen on the second choice food either so we were onto NM for her first and second meals.

she has had it before but not since diagnosis. its about 6% carb. and slightly higher fat than the other two foods.

she ate much more enthusiastically at +4 and she is down to pink numbers and looking reasonably happy again. ketones are 0.2 at +6.

im hoping its going to be a short bounce

we did a lot of testing yesterday when she was in and around lime green and she was getting grumpy about it again so I am trying to give her a little break.
 
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