Dosing Advice for Brie...?

Brie’s Mom

Brie’s Mom

Member
Hi Everyone,

I was wondering if someone could look at Brie's spreadsheet and give some thoughts.

Just to preface - TESTING HAS NOT BEEN EASY... We've been able to start testing occasionally during the day but it has been a really rough go. I know I should get more data but the testing has been so traumatic for her that she was avoiding contact constantly so we have just been doing it before insulin to make sure it's safe enough. It's starting to get better so I have been trying to do more. But I do know 100% that I should have more info on her NADIRs.

She seems to be going in cycles - a few rounds of ok amps/pmps and then a week later back into the 20's (360+). She started out on 1unit twice daily but had some steep drops so the vet dropped down to 0.5 which wasn't doing much at all. She advised not to try 0.75 because it is "hard to administer" but I haven't had any issues with it and she's definitely been doing the best clinically on that dose. Totally back to her old self again - playing all the time, peeing normal amounts, not drinking excess water, she's lost weight and is the healthiest I've ever seen her.

I was originally just SO focused on getting her into remission - the numbers were all that mattered at first. But now with her acting so great I've been having a hard battle... Do I keep her at this dose which is working a good chunk of the time or risk going back to 1u and potentially having her steep drops again when testing hasn't been easy and I don't have the luxury of a freestyle libre sensor anymore.

We're only on month 3.5 since diagnosis and it's been incredible to see the change in her but it's still so new and I don't know when to start pushing more aggressively (higher dose). I don't think she'd still be around if I hadn't found this forum. So thank you so much! She just turned 5 and I know we have a long road ahead but it's definitely less daunting than it was at first!!
 
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Hello there! I'm so sorry that nobody has gotten back to you yet. I have had some very ill cats (emergency room all nighters) lately and haven't been on the Board for several days. But, having said that, it's really hard to advise in this instance because of lack of tests. I'm so sorry to even say that -- I love cats -- I really care about your cat Brie -- and I'm not trying to be a jerk! I promise. But there are so few tests in the last few weeks that it might be dangerous for me to recommend something. I am glad to hear that she it, at least, feeling and acting better. So what happened with the Libre sensors? You cannot do those anymore? Too expensive? I do know that a lot of people place them on their cats themselves. There is apparently a whole facebook group devoted to doing the Libre sensor yourself at home. They have videos to help. But anyway, if that's not an option, do you think you could try to get a +2 test one day and a +4 test on another day? And then try to get the "before bed test" in the evening? A lot of cats do drop lower at night and so if we have only daytime data with no nighttime data, it could drop Brie too low. Is this okay? I guess since she's feeling better she's more feisty?
 
Suzanne & Darcy said:
But, having said that, it's really hard to advise in this instance because of lack of tests. I'm so sorry to even say that -- I love cats -- I really care about your cat Brie -- and I'm not trying to be a jerk! I promise.
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Hi Suzanne! Haha I know you’re not being a jerk - I totally get the needing more tests for data. This week has honestly been really exciting testing wise - she’s starting to get in the groove and ok about testing. So hopefully we can get a few more to fill in some info. I’m a total stats geek so having limited data has been tough.

The freestyle was amazing in the beginning but it was just too expensive ($100 CAD each) - even if I applied it myself. Plus she figured out how to rip off her first one and then needed a recovery suit to keep the sensor on and hated it. I have a chronic illness myself and am on a very limited income so it’s unfortunately not feasible.

Ok so here’s a dumb question because this is still pretty new. Obviously the goal is to be in the blues and high greens but are pinks really bad? My vet said ideally under 16mmol but I know the renal threshold is around 14mmol. She has honestly never been this spunky and athletic in her whole life - even as a kitten. I’m so tempted to just keep everything as it is because she has been doing so well but don’t really understand if this is considered regulated or not currently. On 1u she was sleepier than normal and on 0.5u she was as well. 0.75u seems like the perfect balance and I don’t want to jeopardize that. Such a tricky balance!

I’m so sorry that you’ve been dealing with sick kitties - I hope they are all doing better!
 
I would say that, yes, pinks are really bad - very hard on all of her body systems (including kidneys) and so are the higher yellows.

I understand about the Libre and the expenses! I think it looks like the dose may have gone stale on her, but after you can fill in a few more blanks, we can get a better idea.

As for feeling better in the higher numbers, that’s not unusual. Cats get accustomed to being in a certain range of high numbers and it’s really where they feel most normal. They need to get used to what really are more normal numbers for a cat. Members here report all kinds of strange things when their cats are first getting into better blood glucose numbers — from sleeping too much to hiding to just seeming not well. It’s hard! One of our moderators said her kitty would be happy and playful in yellows and would hide under the bed in low blues and greens. Keep in mind that normal BG numbers for a cat who is not diabetic and not on insulin are about 50-100 and can go lower than 50 and a little higher than 100 - but not a whole lot. So it does take time for them to adjust. This is part of the reason why we see bouncing in response to any number that the cat’s body perceives as “too low” — it’s just whatever they’re not used to. Hopefully we can see a clearer picture soon.
 
Suzanne & Darcy said:
I would say that, yes, pinks are really bad - very hard on all of her body systems (including kidneys) and so are the higher yellows.
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Aw darn! Not what I wanted to hear but I appreciate it!! I have emailed my vet and will discuss increasing carefully. Thankfully this week has been pretty calm testing wise so hopefully she's flipped the switch on now being ok with testing!! People said it would happen - I just never believed it!

Thank you for your help!! :bighug:
 
I see you have increased to 1 unit. I am glad. I think she needs it. Be sure to give snacks in the early part of the cycle. Small snacks of a teaspoon or two of low carb wet food each hour for the first four hours of the cycle will help prevent steep drops.
 
Suzanne & Darcy said:
I see you have increased to 1 unit. I am glad. I think she needs it. Be sure to give snacks in the early part of the cycle. Small snacks of a teaspoon or two of low carb wet food each hour for the first four hours of the cycle will help prevent steep drops.
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Hi Suzanne!! Sorry for the late reply.
She was doing well the first two days which I expected from the carryover but then last night PS we had a crazy reading!! I tested 3 times to make sure it wasn’t a reader error - 25.5 (459), 25.3 (455), and then 23.5 (424). She was 26 one time when she broke into a temptations treat bag and ate a handful but at least that time there was a reason! I thought it might have been a bounce but when I tested amps +5 she was still high at 13.5 (243).

Such a rollercoaster…

I’m also starting to wonder if she may eat some of her poop when she’s really hungry? Have you ever heard of that? Would that raise BG?? I’m going to feed more often as I have just been doing twice per day with insulin (I know not ideal).
 
I see you finally got some action today with that 99! I’m glad to see it really because sometimes it looks like she’s just not responding to the insulin. I hope she got a low carb snack of a teaspoon or two wet food when you got that reading.
 
Oh, and you definitely should try to see if there’s a way to feed her more than twice per day, particularly in the early part of the cycle before nadir.

And as for no poop in the litter box, do you think she could be constipated (which we often see raising BG). Another idea is, what kind of litter do you use? Is it an edible kind like corn, wheat, etc? I suppose she could be eating poop, anything is possible. I would have never thought a cat would do this unless in desperate straits for food. If she’s that hungry then I would definitely feed her more (it can be in some of her new snacks in the early portion of the cycle.)
 
Suzanne & Darcy said:
I see you finally got some action today with that 99! I’m glad to see it really because sometimes it looks like she’s just not responding to the insulin. I hope she got a low carb snack of a teaspoon or two wet food when you got that reading.
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I was actually really scared when I saw the 99! It seemed like such a steep drop from the AMPS. I did give her two teaspoons of low carb food to just level it out a bit. I’m hoping this doesn’t cause any major bounces but I’m expecting it will. That’s why we initially changed doses at the beginning… too much bouncing.

Such a rollercoaster!
 
The good news is that it took her five hours to get to 99. Feeding early in the cycle helps smooth things out and prevent steep drops (when I say steep, I am talking about 100 points or more in a single hour.).
 
Suzanne & Darcy said:
The good news is that it took her five hours to get to 99. Feeding early in the cycle helps smooth things out and prevent steep drops (when I say steep, I am talking about 100 points or more in a single hour.).
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Oh ok! That’s a relief! I’ll look into automatic feeders - I work an hour after her shot so it makes feeding and testing early tricky. That’s why I normally test around +5/+6.
 
As for bouncing, it is super frustrating, but other than feeding those snacks that I have talked about, in order to prevent the fast/steep drops which do usually trigger a bounce — they just need to spend more times in lower numbers in order to get used to them.
 
Brie’s Mom said:
Oh ok! That’s a relief! I’ll look into automatic feeders - I work an hour after her shot so it makes feeding and testing early tricky. That’s why I normally test around +5/+6.
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loads of people here use automatic feeders to dispense snacks while they’re at work or even while they’re asleep.
 
Hi Jessie. How's it going with Brie? I see the bounciness. Do you work at night? I'm just hoping we can get a little more information about what Brie is doing at night -- to see if it's safe to increase and to see if a lower nighttime number is causing some of the higher AMPS. I hope you are well and Brie is feeling pretty good?
 
Suzanne & Darcy said:
Hi Jessie. How's it going with Brie? I see the bounciness. Do you work at night? I'm just hoping we can get a little more information about what Brie is doing at night -- to see if it's safe to increase and to see if a lower nighttime number is causing some of the higher AMPS. I hope you are well and Brie is feeling pretty good?
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Hi Suzanne!
Brie has been having some frustrating readings - they seem pretty all over the place. Clinically she’s been ok though! Slightly larger pees but that’s expected with her random highs. I feel like her 0.75 unit dose was more stable, even though the numbers were still high. This change seems to have made her super bouncy and inconsistent.

I don’t work nights but have a chronic illness myself that makes me exhausted by the end of the day and don’t have enough energy for the ordeal that is testing her. She gets her shot at 9pm so after that it’s pretty much rest time for me. I know it’s not ideal but rationally I know I have to put my health first. When I had the freestyle on her she always was higher at night (except for one night but I think that might have been a reader error) so I’ve been pretty confident that she doesn’t dip low. I have some extra energy today and will try a +2 tonight though.

I’ve started the 1 T of food at +2 and it definitely seems to be preventing large drops so thank you for that! I’m waiting for my Amazon delivery with the automatic feeder so that will be helpful.

I don’t really know where to go from here. I’m going to email my vet tomorrow to discuss but I’m super hesitant to increase because of how bouncy she’s been but I don’t think this is the right dose now.
 
I would try an increase to 1.25. It looks like she needs more insulin, and you don’t want to hold the doses too long. I did want you to hold it longer after the 99 - even though that is a very safe number in the normal range for a cat - to be cautious I think that it is time for an increase.
 
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