Dosing advice for Bunny

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AJHJ

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Hello everyone,

I'd love some advice for Bunny. I had increased his dose to 1.25 based on advice on this board and now have increased it to 1.5 based on his vet's guidance. He's been on 1.5 for 6 cycles now and his numbers are still high. I don't have a lot of midcycle numbers at this dose, but will keep adding them in as I am able. Last night he got to 193 at +5 and today he was at 292 at +5. His AMPS and PMPS levels have been very high. What do you think? Increase? Decrease? Too little data to call? I'd love any insight you may have to offer.

Thanks,
Angela
 
I will be able to get at least a +6 tonight's cycle. Won't be able to get anything else on this one. I'll keep testing as I am around--tough weekend because I have family in town and we'll be out and about a lot. Thank you! I really appreciate the guidance.
 
It's hard to know anything with just the preshots. The black pmps looks more like a bounce, but without a low number, it's impossible to be sure.
 
I got another +5 last night (336) and a +6 this afternoon (422). His +6 today was higher than his AMPS (388). His +5 last night was 336. I'll do some more tests tonight but very concerned about this very high +6. Thoughts? Thank you.
 
I did a mini-curve yesterday and got s few more mid cycle numbers. Bunny's numbers are still very high. I'm giving just shy of 2u (bottom of plunger at the top of the line). I don't think it's a bounce and he's not going below 50% at mid cycle. Would really appreciate some advice. I'm thinking a bump to 2.25 or 2.5 tonight. I really want to get these numbers down. Clinically he seems ok but is still in the litter box a lot. He's not drinking tons of water but I add water to his wet food so he's getting a lot of water that way. Negative for ketones.
 
He dropped 50% yesterday so the insulin is working. But yes, I think he is still too high. We suggest increasing by 0.5 at higher levels IF you can monitor carefully. (Going slower 0.25 at a time is safer, but at higher numbers, 0.5 is okay). It looks like you increased to 1.9 (how are you measuring that?) today from 1.5 two days ago? I'd see what today's cycle looks like - get a mid cycle number- and then evaluate. Two units would be a 0.5 increase from 9/3. I'd definitely get some numbers and give the 2 unit dose a few cycles before increasing further. Maybe three cycles and then increase - depending on his levels.

Good job on the ketones.
 
Thanks, Sue. I noted 1.8/1.9 because I'm just shy of the 2 unit line--bottom of syringe plunger at top of unit line (I add these notes to the comments column). I'll do a real 2 unit dose for a few cycles and see where that takes him.
 
I upped Bunny's dose to 2.0 on 9/5. He's still very high pre-shot and his mid-cycle numbers are not great. I realize I don't have a lot of mid-cycle numbers, but last night was 330 at +4 and today was 384 at +6. His PMPS last night was 560! I didn't get a midcycle yesterday afternoon (working) so I don't know if 560 was a bounce, but today's midcycle is definitely not low! It seems like he is getting worse instead of better--at least in terms of BG. Clinically, he seems the same. I can get more midcycles in the evenings, but won't have a chance during the day again until Friday at the earliest (and then only a +8 at best). Thoughts? I'm getting very discouraged.
 
I am not sure what is going on. Yes, you did get better numbers with lower doses, but you have raised the dose fairly slowly and carefully. You can always try one or two cycles at 1.25 to see if the numbers are better.

There is nothing else going on - no infections, no tooth issues? Still eating low carb - no chance of his getting contraband?
 
It is very strange. Correct... no infections, his teeth are in good shape (even though he hates brushing!), and there is no chance he's sneaking carbs. Both he and his brother have the microchip feeders and both of them get the same, low carb, canned food (Jenkins just gets a little bit less than Bunny). I'll check again tonight at +4 or +5. It's hard to know if I should be going up or down! Perhaps I'll try 1.25 tomorrow night when I can monitor and see what the nadir is. I really just want to see those blue and greens again!

Thank you, Sue, for all your help and support. I really appreciate it. He's such an amazing cat and I can't stand to think that he's not getting what he needs to feel better. I just wish I could figure out the "magic dose"!
 
One other notable detail... he has been experiencing diarrhea. He has always had GI issues. When I first got him from the shelter (he was an adult cat) he had really bad diarrhea. A regimen of yogurt and pumpkin got him back to normal over tiime. He's been on wet food diets before (after having a tooth pulled) and it didn't affect his GI system at all. Since starting insulin he has had diarrhea again. I started him on fortiflora on Saturday. No improvement yet. Tonight I gave him 1 tsp of pumpkin in his food. He just went to the litter box and let me just say it was NOT an improvement! I know it can take some time, but I wonder if this might also be impacting his BG because it has to be stressful for him. I will keep with the pumpkin and fortiflora and see if he improves. Otherwise, I'll bring him to the vet to see if there is anything else that can be done. Just thought that clinical detail might also be important.
 
@Bobbie And Bubba has had success using Florastar probiotics for diarrhea.
Yes I did. The therapeutic dose is : the therapeutic dose is 1/2 capsule twice a day and the maintenance dose is 1/4 capsule twice a day. I continued to use the maintenance dose for about 2 weeks after the diarrhea had stopped.

I also used Slippery Elm Bark then too. But if you use together they have to be 2 hours apart as the SEB can inhibited some meds to work.
 
Thank you! Do you suggest trying Fortiflora or Slippery Elm Bark first?

On the bright side, 304 at AMPS! Best pre-shot number for weeks!!
 
I think I would start with the Florastor. It is a bit pricey about 50 /bottle. You can sprinkle it right in the food undetected. It is S. Boulardii and you can get in cheaper on line a company called Jarrow but the Jarrow puts something called MOS ,in it. (MannanOligoSaccharides) MOS, is an oligosaccharide from the cell walls of S. cerevisiae that can discourage bacteria from adhering to the epithelial cells and reduce their proliferation. It makes it bitter tasting and you wouldn't be able to just sprinkle in the food. You would need to put it in a gel cap and pill Bunny. The Jarrow is about 18 a bottle. The extra cost of the Florastor for the ease of using it is worth it to me.
 
Thank you! I will give the Florastar a shot if the pumpkin/fortiflora don't do the trick. I completely agree about the extra cost being worth the ease of use.
 
Hi everyone... Bunny's numbers seem to be getting higher, instead of lower. I've been slowly increasing the dose but it seems to be having the opposite effect on his numbers. I will get some more midcycle numbers today, but would love some advice. What should I do if his midcycle numbers stay red or pink today? high yellow? Sue, you mentioned possibly trying a 1.25u dose for a few cycles... still worth trying? Or stick with this dose a bit longer? Thank you in advance!
 
I am confused by his numbers. They were better at lower doses. But you have raised slowly and carefully. Is there anything we have missed? What brand/flavor of food? Is he still having diarrhea? Any chance that is a bug of some kind?
 
I'm glad it's not just me! He's eating Weruva Paw Lickin' Chicken (as fed 0.62%, dry matter 3.9%), Mack & Jack (as fed 0.02%, dry matter 0.1%), and occasional FF pate (chicken, turkey, or the seafood ones)--all well under 10%. He is still having diarrhea. I'm getting the Florastar in the mail today, so will try that. The pumpkin might be helping a little bit, but not much. I don't think he has a bug... but, it'd be hard to tell. Other than the diabetes, he was in good health at his last vet visit (everything else was normal).
 
The Paw Lickin Chicken looks good on our food chart, but I notice they have one with gravy. The regular one is 3% carbs, which should be fine. Hope the Florastar works. You might take a sample into the vet to check for parasites or ? (I know he has had the problem a while; I am just trying to brainstorm...)

You might consider a restart. I do notice that you don't have any midcycle numbers for the cycles at 1.25/1.5 Wonder if there is any chance that was a good dose? Sometimes too much can look like too little.....If you decide to lower the dose for a few cycles (and only a few) be sure to get some ketones tests in.

The other puzzler is that the nighttime numbers looks much better than the day. How often is he eating during the day? What time in the cycle? Does he eat at all at night?
 
I wondered about the Paw Lickin Chicken, too. The one with gravy is the only one they have and I was pulling the carb analysis from their website. Still, I'll eliminate that food from his diet for a while and see if it makes a difference. I do have midcycle numbers for both the 1.25 and 1.5. The first day on 1.25 he was at 400 at +5. The second cycle, he was at 184 at +4 and 130 at +7.5. At 1.5 he ranged from 193 to 422. He's allover the board.

As far as when he eats... he eats all day and night. I have the surefeed microchip feeder and he has food available at all times (except 2 hrs before AMPS and PMPS). He probably eats a bit more during the day than night.

So would you try 1.25 tonight?? Or keep at 2.4 and stick to the very low carb Mack & Jack?
 
I think I would stick to the Mack and Jack. You might cut back his food to say, 3 times a day (add water so he feels full ) and see if that makes any difference. How much is he getting total? It is wise to only make one change at a time, but let's not give any change too long.

What are the ingredients on the gravy one?
 
Chicken (Boneless, Skinless, White Breast), Water Sufficient For Processing, Potato Starch, Sunflower Seed Oil, Dicalcium Phosphate, Xanthan Gum, Choline Chloride, Taurine, Vitamin E Supplement, Zinc Sulfate, Thiamine Mononitrate (Vitamin B1), Nicotinic Acid (Vitamin B3), Ferrous Sulfate, Calcium Pantothenate, Vitamin A Supplement, Potassium Iodide, Manganese Sulfate, Vitamin D3 Supplement, Copper Sulfate, Riboflavin Supplement (Vitamin B2), Pyridoxine Hydrochloride (Vitamin B6), Folic Acid, Vitamin B12 Supplement.

Protein Fat Carbs Phos Magnesium Potassium Sodium
Paw Lickin’ Chicken 77.00% 15.70% 3.90% 0.82% 0.06% 0.68% 0.24%
 
Oops... accidentally hit enter before I was done typing.

Above is the ingredient list and nutritional analysis. I switched the food in his feeder to Mack & Jack. He still needs to gain a bit of weight and is hungry all the time so I've been giving him a lot of food. He gets ~1.5, 5.5 oz can in the morning and eats it all day and the about the same in the evening so 3, 5.5oz cans a day. He is not gaining weight yet. He was at 11.1 lbs at dx and was 11.2 today. His weight varies by about .3lbs (probably attributable to stomach/bladder contents at any given time).

So, Mack & Jack and 2.4u?
 
Stranger and stranger... 340 at +9, 248 at PMPS. I went ahead and gave the full 2.4. I'll monitor tonight. I'm curious to see what happens. Generally, his levels rise before the PMPS so this is really odd.
 
Yes, let's hope that's what was driving the weird numbers. He refuses to eat Mack & Jack for every meal so now he's enjoying some Merrick chicken pate.

I'm curious if anyone else has had a similar issue with the Weruva Paw Lickin Chicken raising BG levels. From their nutritional analysis, it looks like it should be one of the best options. Reinforces the need to read labels--buyer beware! :)
 
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