Day Five: Decreased Insulin and Considering Meal Schedule Change

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Jade & George

Jade & George

Member Since 2021
I'm on day five and am struggling a bit. Vet recommended starting with two units twice a day. AlphaTRAK delivered yesterday and caught a very low BG at +3: 35. No serious hypo symptoms - just a pale nose and a little cranky - but I gave her a fingertip of honey and some kibble jic. Watched her carefully at night, grabbing a couple hours of fitful sleep here and there. Decreased dose to 1 unit this morning after an AMPS of 219. Gave her first meal of the day: 1/4 can of Purina DM with a sprinkle of Purina DM kibble (~15 pieces). Feeling frustrated that vet directed starting at 2 units, and also doubting meaningfulness of BG at initial diagnosis (600+) due to extreme vet aversion. I've yet to see a BG over 300, but then again I've probably been overdosing her for four and a half days. Scheduled to see vet at 4pm today to install a FreeStyle Libre but feeling hesitant to bring her back to the vet for the third time in as many weeks considering how much she hates it. I'd like to start feeding her four small meals instead of the two as recommended, but I'm wondering if they need to be spread evenly across all 24 hours or just the 12 daytime hours. I was thinking 8am, 12pm, 4pm, and 8pm: 1/4 can of Purina DM with a sprinkle of Purina DM kibble. This is the food the vet gave me at diagnosis, switching from what I had been feeding her: Nature's Promise grain-free salmon kibble (1/4 scoop in the am) and tuna wet (1/2 small can at night with a small scoop of kibble). I've ordered Royal Canin from Chewy at the recommendation of a friend (the same one that told me about these fora) and my sister who also had a diabetic cat years ago. Sorry for all the rambling, I'm not sleeping much for fear of what I might wake up to.
 
Replied in ProZinc forum as well

The DM is actually fairly high carb, most of us feed low carb fancy feast or Frisked Pates. I'd probably cancel that Royal Canin order if you can, plenty of good foods cheaper. Here is a list of foods and their carb % on a dry matter basis, aim for around 5% carb. Wet really is best, try to avoid too much seafood due to mercury (and also they tend to develop a preference to seafood).

Now I cannot stress this enough - since her numbers are already fairly low, you must be abundantly cautious when changing to a lower carb food. Meaning, change the food over slowly over the course of a week (or more), and while you can be around to monitor and intervene if needed.

As for food schedule, let's see how her trends shake out over next few days. We try not to feed after nadir, since that is when insulin is wearing off. Most of us feed the bulk of meals at preshot time, then some smaller snacks until nadir. Please make sure your preshots tests are fasting for 2 hrs prior for consistency; midcycle tests are not fasting.

The Libre has pros and cons. A lot of people like it as a sort of safety net, but anecdotally it seems to read artificially low in green numbers. Meaning, it may give you an alert that she's at 40, but if you double check with a human or pet meter those may tell you 90 which is perfectly safe. We do recommend double checking any low Libre readings with a human or pet meter. Cost obviously is another thing; they last 2 weeks max, if they don't fizzle out or cat knocks it off before then.
 
Another housekeeping item - do you have a hypo kit? https://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/

For medium carb you will want 10-15% carbs from that list I linked in last post. High carb is 16+%, until you know how he reacts to carbs it's a good idea to have some around the 18% range and some around 22% just in case.

The guaranteed analysis on the cans is not a reliable measure of carbs (some day when you're not overwhelmed we can explain why), so please go off the list I gave.
 
Jade & George said:
I'm on day five and am struggling a bit. Vet recommended starting with two units twice a day. AlphaTRAK delivered yesterday and caught a very low BG at +3: 35. No serious hypo symptoms - just a pale nose and a little cranky - but I gave her a fingertip of honey and some kibble jic. Watched her carefully at night, grabbing a couple hours of fitful sleep here and there. Decreased dose to 1 unit this morning after an AMPS of 219. Gave her first meal of the day: 1/4 can of Purina DM with a sprinkle of Purina DM kibble (~15 pieces). Feeling frustrated that vet directed starting at 2 units, and also doubting meaningfulness of BG at initial diagnosis (600+) due to extreme vet aversion. I've yet to see a BG over 300, but then again I've probably been overdosing her for four and a half days. Scheduled to see vet at 4pm today to install a FreeStyle Libre but feeling hesitant to bring her back to the vet for the third time in as many weeks considering how much she hates it. I'd like to start feeding her four small meals instead of the two as recommended, but I'm wondering if they need to be spread evenly across all 24 hours or just the 12 daytime hours. I was thinking 8am, 12pm, 4pm, and 8pm: 1/4 can of Purina DM with a sprinkle of Purina DM kibble. This is the food the vet gave me at diagnosis, switching from what I had been feeding her: Nature's Promise grain-free salmon kibble (1/4 scoop in the am) and tuna wet (1/2 small can at night with a small scoop of kibble). I've ordered Royal Canin from Chewy at the recommendation of a friend (the same one that told me about these fora) and my sister who also had a diabetic cat years ago. Sorry for all the rambling, I'm not sleeping much for fear of what I might wake up to.
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just looked at your ss... i think you need another reduction. I'd do 0.75
 
You're doing a fantastic job of monitoring. George, however, is giving you a good deal of excitement! Any time you get a reading below 90 on the Libre, you want to reduce George's dose.
 
Also thank you to @FrostD! Your advice has been hugely helpful. My experience with the Freestyle has lined up with what you warned - it reads lows low AND highs high. Examples: Read LO this AM, immediately tested using the AlphaTrak and got 86. Yesterday I had two other low pairs, 83 on the Freestyle was 160 on the AlphaTrak, and 75 on the Freestyle was 127 on the AlphaTrak. I also had it on the other end, when the Freestyle read 242 I tested using the AlphaTrak and got 199. Another time the Freestyle read 344 and the AlphaTrak read 397 but that was within an hour of dinner so I’m sure that was because of the inherent delay of the Freestyle. That high number was my mistake - Georgia was crazy begging for food so I gave it to her (around 7:45pm) and didn’t shoot until her scheduled time of 8pm. I won’t make that mistake again (I hope!). Today I’ve cut out kibble altogether (I’ve been slowly reducing it for a few days) and I can already see the improvement. I’m lucky to have a completely remote job, and very understanding family - my parents live a couple towns over and are being very supportive and understanding that I can’t spend hours at their house like I have in the past without running home to test, feed, and of course get in some snuggles. <3 I’m also getting more sleep than I did in the first few days but I’m really upset that I slept thru a low last night so I wasn’t able to double check with the AlphaTrak and/or give her a snack. I guess I’m getting too used to my cell phone alarms - they didn’t wake me up. Will figure out a better plan soon - might even dig out the old analog alarm clock I used in college and see if it still works! Tho my neighbors might not appreciate that.

Enough rambling. It’s American Thanksgiving and I am thankful for every single person (and kitty!) in this group! Thank you all, so much.
 
Hi Jade if you ever need to bring George's BG up
Med and High Carb food



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs
 
Thank you @Diane Tyler's Mom! I will definitely add these to my next grocery order.

I also plan to give kibble in case of low bg.

As advised, I now know Royal Canin Glycobalance is a more expensive option but my sister and a friend both used it with success with their diabetic cats. Has anyone used it with success or otherwise? It’s due for delivery on Saturday.

I’ve been using Bobby Flay’s Nacho freeze-dried salmon treats for any sticks - they’re great but VERY stinky!
 
Oh and I put on her thunder shirt when she was licking the Freestyle too much the day it was installed. Now she gets mad if I take it off (which I do if I leave the house Bc I’d rather her accidentally rip off the Freestyle then get her thunder shirt caught on something and hurt herself or worse). She looks like a working kitty and it’s TOO CUTE! I’ll try to figure out how to post a picture. <3
 
Jade & George said:
Thank you @Diane Tyler's Mom! I will definitely add these to my next grocery order.

I also plan to give kibble in case of low bg.

As advised, I now know Royal Canin Glycobalance is a more expensive option but my sister and a friend both used it with success with their diabetic cats. Has anyone used it with success or otherwise? It’s due for delivery on Saturday.

I’ve been using Bobby Flay’s Nacho freeze-dried salmon treats for any sticks - they’re great but VERY stinky!
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Hi I did a search on the forum and the members all say
(RoyalCanin Glycobalance is 14% carbs which is not a low carb food.)

Both wet and dry are too high in carbs
If you ever want to try and find up top where it says search type in what you might be looking for and you will see all posts

Also here are the 2 dosing methods for Prozinc, see which one is best for you to follow and put add it to your signature and SS

George looks like a real love bug , he's adorable :cat:
 
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Getting a little frustrated. Ordered Royal Canin bc I was told Purina DM, which my vet gave me, is not ok. Just checked the food list provided above and it has 6 carbs. Thinking I should stick to that, but only have 6 cans left. Wish my old food was on one of these lists - does anyone know the carb content of Nature’s Promise Tuna wet food? It’s Stop and Shop’s in-house organic brand.
 
You can stick with the Purina DM wet if you want to, any reason why you can't feed
Fancy Feast Classic Pate or Friskies?
Most of us feed our kitties that
Fancy Feast Pate has a lot of different flavors
Can't help you out with carb content on the Tuna

One thing
We recommend limiting fish flavors to once or twice a week due to several reasons. One is due to the heavy metal contamination found in a lot of fish these days, mercury being just one of them. Also, fish flavors are higher in phosphorus because a lot of bones end up ground up into cat food and bones are high in minerals. High phosphorus is harder on the kidneys. The last reason is because it can become "addictive" where the cat won't eat anything else. Fish isn't really supposed to be a normal part of any cat's diet. Few feline species include fish as a food source at all (although a few wild cats might snag a fish out of a river or pond now and then but more because it's something that's moving and triggers the hunting instinct than for actual food value)
 
Jade & George said:
Getting a little frustrated. Ordered Royal Canin bc I was told Purina DM, which my vet gave me, is not ok. Just checked the food list provided above and it has 6 carbs. Thinking I should stick to that, but only have 6 cans left. Wish my old food was on one of these lists - does anyone know the carb content of Nature’s Promise Tuna wet food? It’s Stop and Shop’s in-house organic brand.
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Do you have a link to the nutrition facts, or a picture of the analysis on the back of the can? It can be calculated from that info usually
 
Thank you @Diane Tyler's Mom ! I have been avoiding Fancy Feast and Friskies due to a personal preference with the smell. My parents feed their cat those brands and it does not agree with me. I’m very sensitive to smells, and they’re often a migraine trigger. I would, of course, tough it out if I had no other option. I went with the Purina DM bc that’s what my vet gave me. Given her experience and education, I am inclined to trust her advice. I was switching to Royal Canin on the advice of the two people that have been helping me thru this by sharing their experience with a diabetic cat. One of them is the reason I’m here on this forum in the first place, so I’m really confused why her advice is conflicting with the going opinion here. I had reviewed Dr Lisa’s food data but she stated that the carb numbers are estimates only and the difference between 0, 5, and 10 are likely not statistically significant.
 
Jade & George said:
Thank you @Diane Tyler's Mom ! I have been avoiding Fancy Feast and Friskies due to a personal preference with the smell. My parents feed their cat those brands and it does not agree with me. I’m very sensitive to smells, and they’re often a migraine trigger. I would, of course, tough it out if I had no other option. I went with the Purina DM bc that’s what my vet gave me. Given her experience and education, I am inclined to trust her advice. I was switching to Royal Canin on the advice of the two people that have been helping me thru this by sharing their experience with a diabetic cat. One of them is the reason I’m here on this forum in the first place, so I’m really confused why her advice is conflicting with the going opinion here. I had reviewed Dr Lisa’s food data but she stated that the carb numbers are estimates only and the difference between 0, 5, and 10 are likely not statistically significant.
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I really am not sure why your friend would have recommended glycobalance...we see some people feeding it but there really are better foods.

Lordy I hear you on the smell thing! I crack the can, dump it, and run away. A lot of people also feed Tiki Cat, Weruva, Soulistic, or even raw diets. Kinda depends on what you have access to.
 
FrostD said:
I really am not sure why your friend would have recommended glycobalance...we see some people feeding it but there really are better foods.

Lordy I hear you on the smell thing! I crack the can, dump it, and run away. A lot of people also feed Tiki Cat, Weruva, Soulistic, or even raw diets. Kinda depends on what you have access to.
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Thanks for helping me out Melissa :cat:
@FrostD
 
Jade & George said:
Oh and I put on her thunder shirt when she was licking the Freestyle too much the day it was installed. Now she gets mad if I take it off (which I do if I leave the house Bc I’d rather her accidentally rip off the Freestyle then get her thunder shirt caught on something and hurt herself or worse). She looks like a working kitty and it’s TOO CUTE! I’ll try to figure out how to post a picture. <3
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If you go into your photos and copy the pic you want to share, you can paste it on the forum.
 
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This morning G’s BG was too low to shoot! Celebrating even the smallest victories. Her highest BG this morning was 217, exactly 30 minutes after eating. Other than that she has been below 200 for over 12 hours and her last shot was almost 16 hours ago!
 
Guess what that means!

Gotta start shooting lower ;) If it were me, next thing I'd try is full dose at 175 or higher. 150-174 I'd try a half dose. Always assuming you can monitor of course.
 
Tagging @Hshray because George's spreadsheet when he was on ProZinc is perfect example of starting to shoot lower over time
 
Thanks @FrostD !

This morning woke up to BG of just under 300 (299 on her Freestyle, 296 on AlphaTrak), so I gave her .5 units at 6:45am. Will be home with her all day, monitoring closely. Hoping the earlier schedule will allow me to get some more sleep. Still have her in the thundershirt most of the day as she licks her Freestyle too much if allowed.

Are there needles available that have smaller dose increments? I feel like any quarters are really hard to manage.
 
FrostD said:
Tagging @Hshray because George's spreadsheet when he was on ProZinc is perfect example of starting to shoot lower over time
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I have a George too :) When I was using Prozinc I didn’t shoot under 200 at first (or shot a reduced dose), but started seeing much better numbers once I started shooting lower numbers. As Melissa mentioned, I gradually lowered my no-shot number over time and was eventually shooting full doses in the greens. It definitely becomes more comfortable over time, and those good numbers become addictive to see!
 
Hshray said:
I have a George too :) When I was using Prozinc I didn’t shoot under 200 at first (or shot a reduced dose), but started seeing much better numbers once I started shooting lower numbers. As Melissa mentioned, I gradually lowered my no-shot number over time and was eventually shooting full doses in the greens. It definitely becomes more comfortable over time, and those good numbers become addictive to see!
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I didn’t shoot at all yesterday as she stayed under 200 all day. I only gave her .5 this morning since I had given her .75 the day before yesterday. When you shoot under 200, what do you get for nadirs? I’m so worried about a hypo.
 
Jade & George said:
I didn’t shoot at all yesterday as she stayed under 200 all day. I only gave her .5 this morning since I had given her .75 the day before yesterday. When you shoot under 200, what do you get for nadirs? I’m so worried about a hypo.
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I was afraid of hypo too when I first started, but I wish I had started shooting lower numbers sooner because I personally feel like I wasted a lot of time in the beginning (I had trouble testing at first too though).

If you have high and medium carb food and honey or karo syrup, and as long as you can monitor (test), you can steer the numbers to ensure he stays safe. And you will learn how he reacts to all of those too. For example, I have never had to use honey or karo syrup because medium carb food keeps George surfing in good numbers, and high carb food nudges him up if he goes below 50. And just because a cat goes under 50 doesn’t necessarily mean they are hypo (as long as there are no symptoms and they aren’t a super low).

Because insulin is a hormone, it doesn’t act the same in the high numbers as it does in the low numbers…I had trouble wrapping my head around that at first. For example, 3U for my cat took him all the way down from 308 to 81 on 5/17. For that reason, on 6/5 I thought if I shot 3U at 170 BG he would for sure go hypo (because 3U had brought him down over 227 points just before that). In reality, that’s not how it works. For example, once I started shooting lowing numbers, I shot 3U of Prozinc on 6/8 when his pre-shot number was only 177, and he had a nice nadir of 75. He continued having nice nadirs on Prozinc, and although he would drop under 50 and earn reductions, I never had a problem brining him back up with tight carb food. He stayed bouncy on Prozinc though, so I switched to Lantus to help even him out.
 
Ok I’m feeling really stupid. What should I be aiming for? Should I not have dropped to .5 this am? Due to shoot momentarily, she’s up close to 300, confirmed w AlphaTrak meter.
 
Jade & George said:
Ok I’m feeling really stupid. What should I be aiming for? Should I not have dropped to .5 this am? Due to shoot momentarily, she’s up close to 300, confirmed w AlphaTrak meter.
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If he's above 200, you always shoot full dose (unless there's an underlying health issue going on, but we would help guide you there).

I would try lowering your full shoot number to 175, if you can monitor. So 175 and up, shoot full dose.

150-74, I'd shoot half dose, again assuming you can monitor. For now, I would not shoot anything below 150, need more data.

You haven't chosen a dosing method yet, so for now you want nadirs right around 90 (dose is based on nadir).
 
If he ever goes below 90, you reduce your normal (full dose) by 0.25U.

So right now, your full/normal dose is 0.75U. If he goes below 90, your new dose is 0.5U - until he earns another reduction, or needs an increase because he doesn't see green for a few days (this is all in the dosing methods, but while you're overwhelmed we'll help guide you through).

Also no quarter marking syringes. Just eyeball the best you can, some people use calipers but right now I think that's too much to throw at you
 
FrostD said:
If he ever goes below 90, you reduce your normal (full dose) by 0.25U.

So right now, your full/normal dose is 0.75U. If he goes below 90, your new dose is 0.5U - until he earns another reduction, or needs an increase because he doesn't see green for a few days (this is all in the dosing methods, but while you're overwhelmed we'll help guide you through).

Also no quarter marking syringes. Just eyeball the best you can, some people use calipers but right now I think that's too much to throw at you
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Thank you so much Melissa. I’ll keep reading tomorrow when I’m more awake. I’m struggling with the inaccuracy of the Freestyle, and I’m afraid to go to sleep until at least six hours after I’ve given her insulin, but I’m doing better every day thanks to you.
 
Often times they will seek out food if they start dropping fairly fast, or getting on the low side. Have you noticed him doing that?

I free fed Mr Kitty as well. It was comforting knowing he'd eat when he needed too, and when we really got to lower numbers I would.just sometimes leave MC out so I could sleep.

Ok sorry I probably mentioned before, would changing your shoot schedule help? Sometimes people choose to do something like 5a/5p, or even 3a/3p so that it's just getting up once at night for the shot, but the "exciting" part of the cycle is part.of the day
 
I don’t free feed her bc she overeats and needs to lose a few lbs. I moved her shot to 645 this morning but I don’t always wake up to alarms, especially when I’m really tired. I’ve been known to sleep thru thunderstorms, hurricanes, and even a tree falling into (and I mean INTO) my house.
I swear she’s messing w me tonight - she just acted SUPER unsteady on her feet and I scooped her up to feed her and now she’s acting normal and bg is over 100. I gave her about 10 kibble jic. How do I know it’s the Freestyle that’s inaccurate and not the AlphaTrak?
 
Do.you have control solution for AlphaTrak? If that shows everything is working then I wouldnt worry. I've honestly never seen an AlphaTrak read way off except with a random bad strip, or wrong code used. The Freestyles I unfortunately see a lot, 2 in the past month in fact
 
Day 12 and what a difference. I’m learning to trust my gut (and test to confirm). I’m getting pretty sick of the inaccurate “LO” readings on the FreeStyle but I do think it has helped understand overall trends. Thank you all for your amazing support! Hoping I can give back sometime soon.
 
Sorry, I know it's frustrating! You're certainly not the first. Are those LOs why you're testing so much with AT? If you're seeing numbers above 100 hourly testing is fine - unless youre seeing big drops, then maybe 30mins. Testing every 15 minutes is really only needed if they're in dangerously low numbers (so 50s or lower on AT) and getting honey/karo. I just know those strips are expensive!

Are all numbers from the Libre unless otherwise noted?
 
Part of the reason I ask - it's a little hard to see at a quick glance what's happening. Some people have a separate Libre tab, but perhaps instead you could give each day two rows for BG? Libre on top, AT on bottom? And just merge the rows for the date and dose
 
Yes all numbers are Freestyle Libre unless marked.

I love the idea of the two rows I’ll try that tomorrow!

I know I’m testing a lot. I’m a data analyst by trade and have an anxiety disorder that hasn’t been very well controlled as of late. I’m also trying to make sure I can leave her safely on Friday when I need to take my mom to Yale for chemo. I haven’t left her for more than an hour since she was diagnosed, and even that was only a few times. Don’t worry, I’m talking to my therapist regularly. I’ll try to pull back, but it might take a while.
 
Jade & George said:
Yes all numbers are Freestyle Libre unless marked.

I love the idea of the two rows I’ll try that tomorrow!

I know I’m testing a lot. I’m a data analyst by trade and have an anxiety disorder that hasn’t been very well controlled as of late. I’m also trying to make sure I can leave her safely on Friday when I need to take my mom to Yale for chemo. I haven’t left her for more than an hour since she was diagnosed, and even that was only a few times. Don’t worry, I’m talking to my therapist regularly. I’ll try to pull back, but it might take a while.
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No worries! I just wanted to make sure you knew you didn't need to do it that often. We get a surprising amount of "data people" here, testaholics we call them lol

One skip on Friday won't hurt, her numbers and dose are low enough that a skip doesn't concern me. That way you don't have to worry about her at all and focus on your mom. Since ProZinc is an in and out insulin (and she's not getting a crazy duration from it), no insulin = no hypo = no worries.

That said - the tests you do on skip cycles do give good data. You can see her pancreas isn't working much, but will hopefully get there soon. If it was working more, her BG would naturally come down after eating
 
I’ve been feeding her three times - when I give her insulin, 1-3 hours later, and 1-3 hours later again. That might be messing with any natural decline after eating. It’s working really well for her (and in turn me!) though! I had tried feeding only twice a day when that’s what my vet recommended and I felt like I was torturing her (and in turn me!). ;)
 
Thanks Melissa. My mom has lymphoplasmacytic lymphoma that transformed into large b-cell lymphoma. Yesterday was round six (of six!) of her chemo protocol! She was diagnosed (with LPL) back in 2007, so we’ve been on this road for a while, and she’s doing great. Thanks for asking!
 
Jade & George said:
Thanks Melissa. My mom has lymphoplasmacytic lymphoma that transformed into large b-cell lymphoma. Yesterday was round six (of six!) of her chemo protocol! She was diagnosed (with LPL) back in 2007, so we’ve been on this road for a while, and she’s doing great. Thanks for asking!
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Oh duh I remember! I thought the spreadsheet meant George was starting it.

Glad it went as well as that sort of thing can.
 
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