Checking Freya's Spreadsheet/Dosing Advice

[KrustiKakes]

I finally got Freya's spreadsheet up and running.

Would it be possible to have someone look over it, and see what we have been doing? I think we are starting to see results from her diet changes/being off her antibiotics, but I want to make sure we are doing the right thing.

Her vet wanted us in again this past Friday for a glucose check, but we did not go. It doesn't make sense as he does not talk to us at all about the results. Basically we are told to up her dose, and that's it. I gave them copies of her glucose checks at home, but they do not actually look at those, and only consider the number they get when they test her blood. I plan on going back this week with her chart again, and seeing if we can get them to take the time to look over all her numbers.

Any advice is welcome!

Thank you again!

 

[JanetNJ]

Looks like you are making progress to me. How frustrating that the vet won't communicate better.

 

[Deb & Wink]

Freya is doing ok BG number wise. How is she feeling? How is her appetite and how are the 5 P's (peeing, pooping, preening, playing, purring)?

So now that you have a fair amount of test data, it's time to think about lowering the shoot/no-shoot decision threshold.

Have you read over the Prozinc dosing protocol? SLGS has that automatic dose reduction when your cat has a BG level <90 mg/dL. So, when you got that BG of 74 on 5/30/20 PM cycle, that meant you should have reduced the dose for the next cycle. That would have been 5/31 AM cycle.

Good to see you finally reduced the dose. You do NOT want to go right back up to a 1.25U dose. You want to hold that lower dose for a minimum of 3-6 cycles, and maybe longer. UNLESS Freya gives you another low number <90 mg/dL and that means you lower the dose again.

OK?

 

[KrustiKakes]

Freya seems to be doing okay. I can tell she is still having issues with neuropathy, but I know the Zobaline can take time to work. I plan on keeping her on it because I know it takes time.

Her appetite is good, I cannot think of the last time she didn't have an interest in eating. She can be picky about the Tiki Cat, so we have been introducing Fancy Feast into her diet instead. We still give Tiki Cat, but she prefers Fancy Feast. I do notice she is not aggressive with us and our human food anymore. If we were on the couch with a snack she would jump up, and walk all over us/paw at our hands for food. Now she does not bother us while we snack.

Peeing - Definitely does not seem to go as much, and her amount of urine has definitely decreased. It does seem to increase here and there, and that is when I can tell her numbers are probably higher.

Pooping - This is a hard one. She used to poop 2 or 3 times a day, but the week she was diagnosed she was constipated (this is something that she rarely ever had an issue with, maybe one other time). We gave her miralax a couple of times, and that helped, but then she ended up with diarrhea from her antibiotics. She has been off antibiotics for 4 days now. Her poop is getting more solid, but it doesn't seem like she is pooping all that much. To go from 2/3 times a day to one time (and that one time isn't a large amount) is a bit concerning. We are just keeping an eye on her for now, and we hope her body will adjust after a couple more days. I do not want to reintroduce miralax into her diet unless she needs it.

Preening - The week she was diagnosed she was drinking a lot more water, and ended up with water on her chest. She did not seem to clean it off/clean herself in general. We would end up having to wipe her dry, but she was drinking so much water that her chest was always wet, and getting stinky. Now her chest is dry, and she is back to cleaning herself. She is also back to cleaning her brother/her people.

Playing - She has never been a super playful cat, and in her old age she isn't very playful at all. She prefers to snuggle up with her brother, and sleep on the couch. I would love if she would be a bit more playful, but I am okay with a snuggle bug.

Purring - She has always been big on purring. The week she was diagnosed this was down as well, but now she is pretty much back to normal. She tends to start purring just by looking at her.

Dosing - I read over the ProZinc protocol, but I must admit, I felt overwhelmed, and missed some stuff. I knew to reduce her dose, but then when she was at 170 I think I reduced it too much. I was definitely scared to have such a low pre-shot number, even though I know it was no techinically low. What would be a better number to decide to shoot/noshoot? I know to start they say 200, but I am not sure how low to go with my data I have. I always feel more confident on the weekends when I can be home. I hate not being able to check in with her during my work week.

We will stick with 1U for the next few cycles or so unless we hit under 90 again.

I feel hopeful, and I appreciate your expertise so much.

 

[JanetNJ]

Freya seems to be doing okay. I can tell she is still having issues with neuropathy, but I know the Zobaline can take time to work. I plan on keeping her on it because I know it takes time.

Her appetite is good, I cannot think of the last time she didn't have an interest in eating. She can be picky about the Tiki Cat, so we have been introducing Fancy Feast into her diet instead. We still give Tiki Cat, but she prefers Fancy Feast. I do notice she is not aggressive with us and our human food anymore. If we were on the couch with a snack she would jump up, and walk all over us/paw at our hands for food. Now she does not bother us while we snack.

Peeing - Definitely does not seem to go as much, and her amount of urine has definitely decreased. It does seem to increase here and there, and that is when I can tell her numbers are probably higher.

Pooping - This is a hard one. She used to poop 2 or 3 times a day, but the week she was diagnosed she was constipated (this is something that she rarely ever had an issue with, maybe one other time). We gave her miralax a couple of times, and that helped, but then she ended up with diarrhea from her antibiotics. She has been off antibiotics for 4 days now. Her poop is getting more solid, but it doesn't seem like she is pooping all that much. To go from 2/3 times a day to one time (and that one time isn't a large amount) is a bit concerning. We are just keeping an eye on her for now, and we hope her body will adjust after a couple more days. I do not want to reintroduce miralax into her diet unless she needs it.

Preening - The week she was diagnosed she was drinking a lot more water, and ended up with water on her chest. She did not seem to clean it off/clean herself in general. We would end up having to wipe her dry, but she was drinking so much water that her chest was always wet, and getting stinky. Now her chest is dry, and she is back to cleaning herself. She is also back to cleaning her brother/her people.

Playing - She has never been a super playful cat, and in her old age she isn't very playful at all. She prefers to snuggle up with her brother, and sleep on the couch. I would love if she would be a bit more playful, but I am okay with a snuggle bug.

Purring - She has always been big on purring. The week she was diagnosed this was down as well, but now she is pretty much back to normal. She tends to start purring just by looking at her.

Dosing - I read over the ProZinc protocol, but I must admit, I felt overwhelmed, and missed some stuff. I knew to reduce her dose, but then when she was at 170 I think I reduced it too much. I was definitely scared to have such a low pre-shot number, even though I know it was no techinically low. What would be a better number to decide to shoot/noshoot? I know to start they say 200, but I am not sure how low to go with my data I have. I always feel more confident on the weekends when I can be home. I hate not being able to check in with her during my work week.

We will stick with 1U for the next few cycles or so unless we hit under 90 again.

I feel hopeful, and I appreciate your expertise so much.

It's safe that you reduced at that low preshot because you have no part data to know how she would have responded.

 

[Deb & Wink]

That is an excellent condition report on Freya! Good appetite and the 5 P's are good too.
Most cats only poop once a day, normally. Miralax can be given long term if needed, or you can try adding a tiny bit of plain psyllium hush fiber to Freya's food. Maybe 1/8th teaspoon once a day to start, if you think her poops are too hard.

As you gather more data, you can shoot almost any BG number over 150. For now, you might feel ok giving Freya her regular shot if she is down to 190 or so. With time, you can lower that decision threshold, what some folks call the shoot/no shoot number, a little bit more until you get close to the 150 BG. Maybe lower it 10 basis points each time, over time.

With more time and data, you can learn to shoot any pre-shot BG over 50 mg/dL. Know thy cat. How she will react, how much different carb percentages (low/medium/high) of food raise her BG levels and how fast, when her onset is, nadir and duration, etc.

We do want to find a dose that you can give Freya the same amount twice a day.
I'm betting that she dropped even lower than that 100 BG last night, 6/1/20.
So the reduction this AM, 6/2/20 was a good idea.

Do you know about the stalling technique? Where you do not feed, retest again in 20 minutes, and see where the BG number is at.

If higher (and I mean by a good 25%, more than just the meter variance) than you will be shooting into a rising BG level and it's likely to be safe to shoot.

If the number is about the same (within the 15-20% meter variance), then do not feed, retest again in another 20 minutes. You can repeat this cycle of test, no food, retest for a good 1 hour with Prozinc, and still be able to keep to your shot schedule for the next cycle.

If the number is dropping, and keeps dropping, you are better off going with a reduced dose or skipping the insulin shot all together.

Make sense? Or at least a little bit more sense to you?

 

[KrustiKakes]

That is an excellent condition report on Freya! Good appetite and the 5 P's are good too.
Most cats only poop once a day, normally. Miralax can be given long term if needed, or you can try adding a tiny bit of plain psyllium hush fiber to Freya's food. Maybe 1/8th teaspoon once a day to start, if you think her poops are too hard.

As you gather more data, you can shoot almost any BG number over 150. For now, you might feel ok giving Freya her regular shot if she is down to 190 or so. With time, you can lower that decision threshold, what some folks call the shoot/no shoot number, a little bit more until you get close to the 150 BG. Maybe lower it 10 basis points each time, over time.

With more time and data, you can learn to shoot any pre-shot BG over 50 mg/dL. Know thy cat. How she will react, how much different carb percentages (low/medium/high) of food raise her BG levels and how fast, when her onset is, nadir and duration, etc.

We do want to find a dose that you can give Freya the same amount twice a day.
I'm betting that she dropped even lower than that 100 BG last night, 6/1/20.
So the reduction this AM, 6/2/20 was a good idea.

Do you know about the stalling technique? Where you do not feed, retest again in 20 minutes, and see where the BG number is at.

If higher (and I mean by a good 25%, more than just the meter variance) than you will be shooting into a rising BG level and it's likely to be safe to shoot.

If the number is about the same (within the 15-20% meter variance), then do not feed, retest again in another 20 minutes. You can repeat this cycle of test, no food, retest for a good 1 hour with Prozinc, and still be able to keep to your shot schedule for the next cycle.

If the number is dropping, and keeps dropping, you are better off going with a reduced dose or skipping the insulin shot all together.

Make sense? Or at least a little bit more sense to you?

Hi Deb, I have kept Freya on 1U for a little over a week now. Seeing her numbers should I keep this dose, or move her back up to the 1.2? Should I stick to 1 and do a daytime curve this Saturday, and evaluate then?

 

[Deb & Wink]

The 65 BG at +4 on 6/15/20 PM cycle actually earned Freya a 0.25U dose reduction, per our Prozinc SLGS dosing protocol. Have you printed out and read that Sticky post?

Could you reduce to 0.75U please.
Then, would a curve on Sunday instead of Saturday be possible for you? To see how Freya is doing on the reduced dose.

Freya is dropping low enough in the middle of the cycle, into the greens (<99 mg/dL) and the blues (100-199 mg/dL) to allow her pancreas time to heal.
Looks like the antibiotics made a big difference in her BG numbers.

 

[KrustiKakes]

The 65 BG at +4 on 6/15/20 PM cycle actually earned Freya a 0.25U dose reduction, per our Prozinc SLGS dosing protocol. Have you printed out and read that Sticky post?

Could you reduce to 0.75U please.
Then, would a curve on Sunday instead of Saturday be possible for you? To see how Freya is doing on the reduced dose.

Freya is dropping low enough in the middle of the cycle, into the greens (<99 mg/dL) and the blues (100-199 mg/dL) to allow her pancreas time to heal.
Looks like the antibiotics made a big difference in her BG numbers.

I definitely can print out a copy when I am in my office tomorrow. I can do a curve on Sunday instead if you think it would be better. I am excited because she is doing so much better. She seems so happy again. No more litter box accidents (she would get in the box, but wouldn't have the strength to squat), and I can tell her neuropathy is getting better (her fur is growing back on the bottoms of her feet). She is still annoyed about glucose testing (but always hops up onto her "testing stool" when it is time), and is pretty good about getting insulin as long as she has a hand to lick at the same time. I am also seeing health improvements in our non-diabetic cat as we are slowly removing dry food from his diet as well.

Thank you!!

 

[Deb & Wink]

I suggested the curve on Sunday instead of Saturday, to give a bit more time to see how Freya is doing on the dose reduction. But I see you did not take the earned dose reduction to 0.75U as I suggested. Ok then, either Saturday or Sunday, whichever works better for you and the thousand and one things you have to get done on the weekend.

But Freya really did earn a reduction to 0.75U. When a cat drops below 90, there is no reason to stay at the higher dose unless your cat has ketones or is a long term (> 1 year) diabetic.

Yes, non-diabetic cats, aka "civies", benefit from the low carb canned foods too. Some cats are easier to switch than others. All my "civies" were very happy to be eating canned food instead of dry.

Have you seen the Transitioning Dry Food Addicts to Canned Food article, by Dr. Lisa Pierson? It was a life saver, when I was trying to switch Wink. He was the founding member and past president of DFAA, Dry Food Addicts Anonymous.

 

[KrustiKakes]

I suggested the curve on Sunday instead of Saturday, to give a bit more time to see how Freya is doing on the dose reduction. But I see you did not take the earned dose reduction to 0.75U as I suggested. Ok then, either Saturday or Sunday, whichever works better for you and the thousand and one things you have to get done on the weekend.

But Freya really did earn a reduction to 0.75U. When a cat drops below 90, there is no reason to stay at the higher dose unless your cat has ketones or is a long term (> 1 year) diabetic.

Yes, non-diabetic cats, aka "civies", benefit from the low carb canned foods too. Some cats are easier to switch than others. All my "civies" were very happy to be eating canned food instead of dry.

Have you seen the Transitioning Dry Food Addicts to Canned Food article, by Dr. Lisa Pierson? It was a life saver, when I was trying to switch Wink. He was the founding member and past president of DFAA, Dry Food Addicts Anonymous.

Hi Deb,

I just finished Freya's curve, and was hoping you would have some thoughts. I will be sticking with her .75U dosage for the time being, unless you think she would benefit otherwise.

Today has been a long day. My other cat has been fine all day, had a huge evening poo, and now he is lethargic/not interested in food. Hoping he just has a bit of an upset tummy. Ahhh, the joys of having 2 senior kitties.

 

[Deb & Wink]

That curve you did looks pretty good. That 92 at +4 on 6/21/20 is close enough to the 90 reduction point for SLGS that I would suggest you reduce to 0.5U.

Freya may not hold the good numbers with a dose reduction, but again she might. Worth a shot to reduce the dose at this point and see how she does. Don't worry if her BG levels go into the yellow ranges again for a few cycles. I'm thinking that a reduction, because her nadir is so close to the 90 reduction point so often in the last week or so, that a slightly smaller dose might do the trick for Freya.

Are you willing to try that reduction to 0.5U?

Worst case, after 6-10 cycles at the reduction dose and if Freya's BG's at mid-cycle are too high, then you increase the dose a tad again.

 

[KrustiKakes]

That curve you did looks pretty good. That 92 at +4 on 6/21/20 is close enough to the 90 reduction point for SLGS that I would suggest you reduce to 0.5U.

Freya may not hold the good numbers with a dose reduction, but again she might. Worth a shot to reduce the dose at this point and see how she does. Don't worry if her BG levels go into the yellow ranges again for a few cycles. I'm thinking that a reduction, because her nadir is so close to the 90 reduction point so often in the last week or so, that a slightly smaller dose might do the trick for Freya.

Are you willing to try that reduction to 0.5U?

Worst case, after 6-10 cycles at the reduction dose and if Freya's BG's at mid-cycle are too high, then you increase the dose a tad again.

It seems like her PS numbers are increasing, and this morning she urinated twice within an hour. I am not noticing her drinking a lot more than usual, but I am nervous to lower any further. Do you think holding another couple of days would be okay? If I see numbers increasing, and her urinating more should I still try to decrease?

Thanks!

 

[Deb & Wink]

Pre-shot numbers are always the last to come down, especially with an in-and-out insulin like Prozinc. It's very possible that Freya does not get the full 12 hour duration from the Prozinc either. Not much you can do about that, when using Prozinc.

It seems like her PS numbers are increasing,

Remember that 15-20% meter variance. All hand held glucometers are allowed to be off by that much, from test to test. So those numbers you are seeing, are really all in the same ballpark or range.

You are not looking for the exact same number from day to day, from cycle to cycle, but you are looking for the numbers to be trending close to each other.

Do you think holding another couple of days would be okay?

Yes, you could hold the dose for another couple of days. But if Freya goes below 90 again, you need to reduce. We always tell people that they know their cat better than we ever will. Plus, you are the ultimate decision maker, and we are sharing our thoughts and recommendations.

More frequent urination could be due to the hotter weather and her drinking more. Are her pee puddles increasing in size, or are they simply more frequent?
A UTI could also cause more frequent urination.