Diet change working wonders! Now concerned about high insulin dose

Diane Tyler's Mom said:
@FluffyP
Hi if you are following SLGS method
When following SLGS with the Alpha Trak you reduce if the BG falls under 90. Which I see Fluffy did today .
I will tag Suzanne and Shelly just to confirm this
I assume you would reduce by 0.25 units so the new dose would be 5.25 units
Can you add to your signature SLGS and what you are feeding Fluffy
By the way Fluffy is adorable!
@Suzanne & Darcy
@Shelley & Jess
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So I think what we did was a really rushed and not properly tested version of SLGS after his initial diagnosis and subsequent vet visits. He was diagnosed in January and they kept raising his dosage every month only doing monthly visits. He was also on very HC Dry food the entire time so I think the dosage was heavily inflated. That's the main reason I've been toying with the idea of bigger reductions than normal.

I got a little higher PMPS reading than AMPS but committed to 5 units and we'll how that goes this cycle.

Added the info to signature as well.
 
Diane Tyler's Mom said:
@FluffyP
Hi if you are following SLGS method
When following SLGS with the Alpha Trak you reduce if the BG falls under 90. Which I see Fluffy did today .
I will tag Suzanne and Shelly just to confirm this
I assume you would reduce by 0.25 units so the new dose would be 5.25 units
Can you add to your signature SLGS and what you are feeding Fluffy
By the way Fluffy is adorable!
@Suzanne & Darcy
@Shelley & Jess
Click to expand...
Yes. We actually reduced Fluffy’s dose by more than the SLGS protocol. We have reduced it by a full .5 units for now. Thanks, Diane.
 
So far, it looks like we have found a good safe dose for Fluffy for the time being, at least. Do you feel confident about it for returning to work tomorrow?
 
Suzanne & Darcy said:
So far, it looks like we have found a good safe dose for Fluffy for the time being, at least. Do you feel confident about it for returning to work tomorrow?
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I'm quite pleased with the numbers. Didn't get to test as much this cycle as the past two, but I tried to hit the key times based on the previous patterns. I'm feeling good about this dose while I'm at work though.

If I get a much lower preshot reading than usual before I leave for work I'll play it very safe and use a more conservative dose but I think what I'm seeing so far is encouraging.
 
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He's on a mission! :D

Looking at the last reduction, I thought we might see green the 3rd cycle this reduction too!

How's he doing and feeling?
 
Shelley & Jess said:
He's on a mission! :D

Looking at the last reduction, I thought we might see green the 3rd cycle this reduction too!

How's he doing and feeling?
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Haha no kidding. Little dude's got me working overtime. He seems to be doing really good though. He's not overly mobile quite yet but he's definitely getting around the place more than last week that's for sure.

He'll also start on zoballine with today's meal so hopefully that goes well. I may reduce today's AM dose a little while I go to work today just out of an abundance of caution. I'm encouraged by what I'm seeing though. :cat:
 
It hasn't been a week yet, until we're sure all HC dry has left his system and he's had time to settle in, to be safe, I'd reduce too. Let the numbers guide you.

Good to hear he's doing a bit better - that's what it's all about, it's not just about the numbers, sometimes we forget that.
 
@FluffyP

You've done fantastic these last 4-5 days. Your dedication to Fluffy shines through loud and clear! We know what the worry is like and what it's like to loose that kind of sleep. Please take the time to be good to yourself. You deserve it!
 
Fluffy! Go Fluffy! He wants another reduction :) If Fluffy were mine, I might cut the dose to 4.5 since I was not going to be home for the entire cycle. Of course, I don’t know what his preshot number will be yet, so I am only speculating if it’s similar to the last two days AMPS.
 
He ended up at 334 which is a little higher than the last couple of days, but for peace of mind since I'll be at work for the first time in a few days I'm gonna commit to just 4.5 to be safe, since he's shown me a couple times he can cut those numbers down pretty quick.
 
Had a family member go check on him and run a few tests. He didn't eat his snacks cause he wasn't paying attention to the automatic feeder. Ended up sub 90 again even on the 4.5 units, although that was without the LC snacks. Ended up having one at +5.5

Might take him a while to get used to the feeder but I'll try and encourage his curiosity with it. Might go down to 4 now? It seems like he's adamant on cutting into those greens regardless
 
He will get used to the feeder, I am sure. I definitely would reduce by another half unit down to 4 units! Awesome. So nice that your family could test! Fluffy must be a real sweetheart.
 
Just got home from work and wanted to do a test to make sure he was in the clear but he immediately began hissing at me even as I was getting close. I was able to do it but he was very very agitated.

He's always been the biggest sweetheart and never aggressive towards me. He's NEVER hissed at me before so this is really really concerning. He apparently was also hissing at my sister who came over for him and he's always had a positive relationship with him too, and he began hissing at my other cat which is strange too.

I feel like he's been a little more reclusive today than prior days. Maybe something else is wrong? I'm not sure how to feel about it all.
 
FluffyP said:
He's NEVER hissed at me before
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Jess had one of those days, hissed at me once, took me by surprise, I looked at her and laughed "Did you just hiss at me?" And she used to get so cranky when she was yellow, moan and groan about everything - I used to call it her 'Drama Queen Yellow Self!'

He may just be having a bad day, missing all the attention he's been getting lately and feeling a little off.
 
So last night I just hit my physical and mental limit. And his reaction last night to me wanting to test him just really broke me down. He's never displayed that kind of aggressive behavior towards me but it was clear he was just tired of being woken up multiple times throughout the night and poked. I told myself both me and him needed a full night's sleep and that I wouldn't wake either one of us up overnight to test so that we could both rest. That's why I ended up just doing a conservative 3.5

To be honest with everyone, the most important thing to me with fluffy is our bond. He's always been super close to me but last night was his way of telling me he was tired. I feel like if the frequent testing, especially overnight, is going to drain both of us and damage the bond between us then I have to reevaluate whether it's worth it. I really really do want the best of us but I have to consider what it'll cost us.

I hope everyone understands where I'm coming from, and I'm assuming y'all have been in my shoes with this so you know where my heads at. I just have lots to think about. So yeah I basically just wanted to be ultra conservative last nights cycle and this AM cycle since he wouldn't be tested much outside of his pre dose times. Maybe it's just a matter of us finding a nice middle ground and balance when it comes to the testing process., it just unfortunate that that comes with risks as well. :(
 
You'll see times/notes on my spreadsheet where I reduced and/or skipped shots when I needed sleep/had a bad headache or needed a break from whatever else was going on.

You NEED to take care of yourself so you can take care of Fluffy and your other kitty too. :bighug::bighug:
 
I do understand. I was afraid that’s what it was. You have been testing a LOT at night and it does not look like you have been sleeping and waking up to get a test and go back to bed. It looks like you’ve just been staying up. That’s not good for you. You can’t keep it up indefinitely.

It is important to try to get at least one test for each cycle (which you can’t do in the a.m. cycle on workdays, I realize.) If you can get a +3 or something in the p.m. that would be great — or go to sleep and set one alarm to wake up and test at +5 or +6?

With regard to Fluffy’s behavior, there could be multiple things going on. I hope none of them are because he doesn’t feel well. If he’s in really high BG (like that black) that could make him feel terrible. I have definitely seen that in cats here. But also, the opposite can be true. When a cat isn’t used to being in normal glucose numbers, it’s not uncommon for them to feel really strange — some cats will actually hide themselves away. Some become lethargic. It can happen with normal BG (greens like yesterday) or high BG. Some cats don’t even like 200s or higher. Every cat is different in that respect. Also, be sure to give Fluffy a treat with every single BG test. You are probably already doing that. I understand about your bond with Fluffy. You don’t want to harm Fluffy by keeping him in BG that’s too high (especially above the kidney threshold) and you don’t want to upset him. It’s still very new for him and maybe he is having an adjustment period. How did he act otherwise— I mean after you left him alone last night? Or this morning? Does he seem normal? Appetite still good?
 
Suzanne & Darcy said:
I do understand. I was afraid that’s what it was. You have been testing a LOT at night and it does not look like you have been sleeping and waking up to get a test and go back to bed. It looks like you’ve just been staying up. That’s not good for you. You can’t keep it up indefinitely.

It is important to try to get at least one test for each cycle (which you can’t do in the a.m. cycle on workdays, I realize.) If you can get a +3 or something in the p.m. that would be great — or go to sleep and set one alarm to wake up and test at +5 or +6?

With regard to Fluffy’s behavior, there could be multiple things going on. I hope none of them are because he doesn’t feel well. If he’s in really high BG (like that black) that could make him feel terrible. I have definitely seen that in cats here. But also, the opposite can be true. When a cat isn’t used to being in normal glucose numbers, it’s not uncommon for them to feel really strange — some cats will actually hide themselves away. Some become lethargic. It can happen with normal BG (greens like yesterday) or high BG. Some cats don’t even like 200s or higher. Every cat is different in that respect. Also, be sure to give Fluffy a treat with every single BG test. You are probably already doing that. I understand about your bond with Fluffy. You don’t want to harm Fluffy by keeping him in BG that’s too high (especially above the kidney threshold) and you don’t want to upset him. It’s still very new for him and maybe he is having an adjustment period. How did he act otherwise— I mean after you left him alone last night? Or this morning? Does he seem normal? Appetite still good?
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I think in the future it might be easiest to get one reading at pm +3 or pm +4, as I've always stayed up late in general because of my work schedule. I can also experiment with the +6 alarm on days when I want to sleep earlier. I guess the problem is this is all very new to me so seeing low blues and greens sets off panic alarms for me so I end up staying up to test multiple times. I think I need to find a way to find the balance for both of us.

With regards to his behavior after I left him alone he calmed down a lot, he still wasn't happy about the test before the pm dose but I think he pushed through cause he was looking Forward to his meal. His appetite is still very much intact. He ended up hanging out on the couch with me for a bit after he ate so I think the time to calm down helped.

This morning his demeanor seemed good as well. Once again came to hang around. I can tell he was getting annoyed during the testing process but he was patient enough to let me get the reading. I think overall I've noticed he becomes much more lethargic and almost reclusive around the nadir points. I think youre spot on that the unusual low numbers for him make him not feel very well or strange at least. He's normally much more active a few hours before and after feeding times.
 
It is totally understandable about being nervous when the blues and greens come. You always wonder if/when your cat will stop! The only real antidote for that is time and data - knowing your cat's patterns and just becoming more comfortable with the lower normal numbers that neither Fluffy nor you are used to at this time. One of our moderators talks about how her cat was lethargic and hid under the bed in green and was active and seemed happy in higher numbers. Some liken it to being used to drinking a lot of caffeine all the time and then having it taken away. I actually see it in a lot of people’s cats. @Shawn & Sir Maximus
 
In fact, @FluffyP you might want to take a look at Sir Maximus’ spreadsheet when you get a chance. He started out in high numbers and on a much larger dose than he is now. He was very bouncy as well. I think that sometimes Shawn was about to pull his hair out. But now look as his numbers on only .25 units. I am really proud of that.
 
Ohhh I'll take a look at that. Honestly I feel confident that we're on the right track with dosages. I just want to make sure I can do it in a way that preserves his overall quality of life.

I ended up going 3.5 again today cause I'm not sure anyone can test today while I'm at work or if he'd allow someone else to do it. And he also hasn't grasped the feeder despite some efforts, so without the snack I wanted to play it a little safe. The other cat likes to steal it if she notices it before him :cat:.
 
Oh. I didn’t realize there was another cat in the mix! That complicates snacks. Some people use one of those microchip feeders for that.

Be sure to give him something like a Pure Bites freeze dried piece of chicken breast or similar treat with every single test - even if you fail to draw blood or if he growls or hisses.
 
Suzanne & Darcy said:
Oh. I didn’t realize there was another cat in the mix! That complicates snacks. Some people use one of those microchip feeders for that.

Be sure to give him something like a Pure Bites freeze dried piece of chicken breast or similar treat with every single test - even if you fail to draw blood or if he growls or hisses.
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Normally he's very on top of the food business and wastes no time when there's wet food out. The other cat, Eve, has never been one to fight him over food. If he wants the food she'll let him have it. She's much smaller and doesn't want to put up a fight over it. Only problem right now is that he's just not aware of the snacks at all so if an hour or two passes and she sees it sitting there she'll grab it.

I have a camera inside where I can see them and the +2 snack has been sitting on the feeder for a good hour since he's been sleeping in the other other room under the bed. Eve may have noticed it but hasn't Even gone to check it out.
 
Suzanne & Darcy said:
In fact, @FluffyP you might want to take a look at Sir Maximus’ spreadsheet when you get a chance. He started out in high numbers and on a much larger dose than he is now. He was very bouncy as well. I think that sometimes Shawn was about to pull his hair out. But now look as his numbers on only .25 units. I am really proud of that.
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Yes there were many many nights i went to bed wondering if I was ever going to get him regulated into good numbers. It was very aggravating going thru all the stages of his bouncing but i said to myself keep fighting for him and do everything you can and there will come a day he will become healthy and see good numbers. Thankfully will all of Suzanne's guidance and members on this forum he is regulated. Hopefully one day i can get him into remission!

When you start seeing those greens and blues don't be afraid of those numbers and embrace them. You can look back at Fluffy's chart and see his patterns and this will start to ease your mind when he gets down into those low numbers. I have many posts where Suzanne and i have went step by step on how to manage low numbers all the way down into the low 50's. When he was bouncing a lot he would sleep constantly as expected because he didn't feel good going from the highs and lows. It will take time and a lot of dedication but you will get Fluffy regulated soon just take it day by day and do the best you can for him. Good luck and stay positive and feel free to private message me if you have any questions....
 
Shawn & Sir Maximus said:
When you start seeing those greens and blues don't be afraid of those numbers and embrace them. You can look back at Fluffy's chart and see his patterns and this will start to ease your mind when he gets down into those low numbers. I have many posts where Suzanne and i have went step by step on how to manage low numbers all the way down into the low 50's. When he was bouncing a lot he would sleep constantly as expected because he didn't feel good going from the highs and lows. It will take time and a lot of dedication but you will get Fluffy regulated soon just take it day by day and do the best you can for him. Good luck and stay positive and feel free to private message me if you have any questions....
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Yeah I think this is the most important part for me. My fear of those low numbers can be overwhelming sometimes. I really really am trying to do my best to stay positive but hearing stories and experiences like yours makes it easier to feel like there's light at the end of the tunnel.
 
Last night was a bit strange, I know it's hard to pick up and identify patterns when I can't really test during work days but I was so surprised to see a blue PMPS number. Once again I tried to be conservative with my dose and did 3 units. He stayed so flat in his 2 overnight tests that I'm questioning whether that PMPS reading was an error?

Sometimes I feel like I'm being reckless lowering dose constantly but I'm always trying to give te safest dose while trying to maintain a level of efficiency. Everytime I've lowered though it seems like his BG numbers have responded well, but it's hard for me to interpret the numbers all the time.

Does anyone have any suggestions on ways i can help heal his ears? I feel like one of the primary reasons he's fighting the testing process now is that his ears may be a little sore and that's causing him to lash out. He's a white cat so its easy to see all my marks on his ears so it may exacerbate the issues but anything I can do to help make the testing process easier will go a long way i think.
 
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Hi. About the unexpectedly low PMPS reading, we need to talk about meter variance. These glucose meters are allowed to have up to a +/- 20/25 percent variance, which means that the 192 PMPS you had last night is not much different than the 223 that you had two nights before (and you shot 5 units that night and he did well.). You can sometimes test the same drop of blood and get a value that is 20 percent higher or lower — but sometimes you will get something very similar. The time that we really need to just take the meter at face value is when we are dealing with greens. If ever getting a BG test that is unexpected, it’s a good idea to retest. I realize that right now he’s been grumpy about it though so do what you can.
 
According to SLGS protocol, right now, Fluffy’s dose should be 4.25 after the last reduction he earned on May 23 when he received 4.5 units and dropped just below 90. I don’t really think it’s in his best interest to keep chopping and changing the dose quite this much, but I get it. When will you have a few days off again to o get some daytime tests done if he will allow it?
 
Suzanne & Darcy said:
According to SLGS protocol, right now, Fluffy’s dose should be 4.25 after the last reduction he earned on May 23 when he received 4.5 units and dropped just below 90. I don’t really think it’s in his best interest to keep chopping and changing the dose quite this much, but I get it. When will you have a few days off again to o get some daytime tests done if he will allow it?
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I will be off the next three days. I'm confident I can get at least pre shot readings and a +5 or +6 reading since that seems to be his nadir. I was able to pretty easily get the +4 and +6 readings overnight. He was so sleepy I dont think he had the energy to really fight me about it, and I was able to do it quick enough that we were both able to go back to bed. I'll go back up to 4 units tonight? Do you think that's a good idea?
 
Do you alternate between both ears? Do you move slightly up and down the edge area of the ear that is outside the marginal vein so that you aren’t hitting the same spot? What size lancets are you using. If his ears usually give blood and you are pretty good at testing, you can move to a tinier lancet. I used 30 gauge ultra thin lancets. You aren’t using the lancing device are you? I always just did it free hand to have more control. Also, go in at about a 45 degree angle. Some people put a little pure coconut oil on their cat’s ears. I would try Colloidal Silver gel like Silverquine
Silverquine Pet Wound & Itch Care | Dogs, Cats, Horses, Skin & Coat Care, Hydrogel Liquid Bandage, Healing on Cuts, Hot Spot, Burns, Skin Irritation, for Relief & Treatment, Vet Recommended 1.5OZ
https://a.co/d/g31qt5E
 
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FluffyP said:
I will be off the next three days. I'm confident I can get at least pre shot readings and a +5 or +6 reading since that seems to be his nadir. I was able to pretty easily get the +4 and +6 readings overnight. He was so sleepy I dont think he had the energy to really fight me about it, and I was able to do it quick enough that we were both able to go back to bed. I'll go back up to 4 units tonight? Do you think that's a good idea?
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Yes. I would think it’s okay to try 4 units. And maybe you will be able to direct his attention to the automatic feeder, too :cat:
 
Suzanne & Darcy said:
Do you alternate between both ears? Do you move slightly up and down the edge area of the ear that is outside the marginal vein so that you aren’t hitting the same spot? What size lancets are you using. If his ears usually give blood and you are pretty good at testing, you can move to a tinier lancet. I used 30 gauge ultra thin lancets. You aren’t using the lancing device are you? I always just did it free hand to have more control. Also, go in at about a 45 degree angle. Some people put a little pure coconut oil on their cat’s ears. I would try Colloidal Silver gel like Silverquine
Silverquine Pet Wound & Itch Care | Dogs, Cats, Horses, Skin & Coat Care, Hydrogel Liquid Bandage, Healing on Cuts, Hot Spot, Burns, Skin Irritation, for Relief & Treatment, Vet Recommended 1.5OZ
https://a.co/d/g31qt5E
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Yes, I'm alternating as much as possible and I try and move the spots as best as possible. I always aim for that outer portion, I'd say most of the time i get it pretty good but I have missed on occasion and gone closer to the vein than I'd have liked. I usually get pretty good blood amounts as long as I can warm them up well. I've been using the sock with rice but he's starting to hate that part the most.

I use the 28 gauge lancing device that comes with the Alphatrack. I'm not sure I feel comfortable doing it free hand, makes me a little nervous and a bit outside my comfort zone at this time to be honest.

I'll try coconut oil and order that gel as well, see which seems to help the most. Would I apply after each test or maybe just a couple times a day?
 
I would just put it on a couple of times a day. Some cats absolutely hate the lancing device because of the sound it makes — it can be startling.
 
The 28 gauge is thicker than the 30s I used, but when I first started I used a larger size. I bought the ReliOn ultra thin lancets for “sensitive fingers.”
 
Suzanne & Darcy said:
I would just put it on a couple of times a day. Some cats absolutely hate the lancing device because of the sound it makes — it can be startling.
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Surprisingly enough the click has never been too startling for him and I've tried to associate the sound of the click with a treat. What seems to bother him most is the warming of the ears, especially when I apply pressure with the warm sock, and then when I try to massage a little extra blood out after the pricking of the ear. That's why I'm thinking maybe he's sore in that general area. Just overall me "handling" the ear seems to be what bothers him.
 
FluffyP said:
I'll go back up to 4 units tonight? Do you think that's a good idea?
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We sometimes see a flat cycle when kitty is getting ready to clear a bounce - wondering if that's what we're seeing with that flat blue cycle last night.

I wouldn't jump back up to 4 units. I might try the 3.5 units again at the most, as long as you can monitor. Those are fantastic numbers for basically "just starting out" (from the no HC dry point only a week ago).

I know your circumstances are a little different, but, so, I'm also looking at - we raise a dose by 0.5 units if we're seeing nadirs above 200 (if following MPM and in certain circumstances following SLGS) We know 3.0 units brought him into blue. We know he ended the 3.5 unit cycle in blue but don't know what happened at nadir - if that 3.5 units brought him between 90 and 150 at nadir the SLGS protocol recommends hold the dose. We don't know what happened at nadir and why I'd be reluctant to go back to 4.0 units just yet.
 
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Ok, that explanation makes sense to me. Abundance of caution has always been the name of the game for me here. Obviously his change in demeanor towards testing has complicated issues a bit, but I think I'm on board with 3.5 over the next few days and seeing what that looks like unless anyone has any objections?

I also started the zobaline two days ago. I break apart one pill over his morning meal per day. I've seen some people say they do two pills a day? Any thoughts on that as well. His neuropathy is probably the thing I'm most desperate to see remedied, at least to some extent. I know it wont happen overnight though.
 
FluffyP said:
I also started the zobaline two days ago. I break apart one pill over his morning meal per day. I've seen some people say they do two pills a day?
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Feline Diabetic Neuropathy
"The usual dose is between 3 and 5mg (3000 - 5000 mcg) per day, regardless of weight or body size. Methyl B12 is water soluble, so any excess is excreted in the urine- no worries about overdosing."
 
Just an update, at PMPS feeding Fluffy did not want to go near his food. This is highly unusual for him as he ALWAYS has an appetite. I got pretty scared at the sudden loss of appetite. I tried mixing in approximately 1 teaspoon of HC wet food and he began to eat, but then threw up right after. After he threw up he began to eat the rest of the meal normally. I only did 3 units instead of the 3.5 because of the uncertainty of whether or not he would keep his food down. I'll monitor over the next few hours, as of now he has kept it down. In the morning I'll go buy a different flavor of LC wet and see if maybe he was just tired of the chicken flavor.

Edit: ate his snack at +4 and had a very large bowl movement.
 
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This is that grey area shooting low for the first time and he's been in such a hurry to lower that dose! Do you want to start with a token dose of 1 unit to see how he does?
 
Do you think a .5 unit is too little?

He's been on 3 units so I'm just trying to look at that 10-25% number on the dosing guide
 
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