Dosing advice please

M

mariec22

Member
Hello, I am new and have recently posted in the welcome channel. I'm working on the spreadsheet but am confused on filling it in as we've been using the Libre.

Brief history: Cat has only been on ProZinc since first week of Jan 2023. He started on .5 units, which kept his numbers in green zone for about 1.5 weeks then he skyrocketed and hasn't come down since. Now on 4 units. This 4 units is the first time we've actually had any type of curve from him for months (he's been on 4 units for about 15 days). He's been flat and high up until now. My question is, the steep drop to below 5 mmol in his nadir. I read the ProZin dosing guide and it states that if it goes below 5 to reduce dose .25, which I did thsi morning but now his nadir is 14. :-( Is that grounds for dose reduction to 3.75 or hold at 4? Do I just need to be patient and hold at 3.75 or go back to 4 tonight?

Thank you for your help. If you'd prefer the spreadsheet, I can sort that out. I'm just confused on how I input his numbers for his evening preshot since he's generally over 27 for them and I don't see a space at the top for PMPS BG that goes above 16 (but honestly spreadsheets aren't my friend so it may just be me being thick!)

Thank you for any and all help and support. I really appreciate it.

**EDIT** images appear too small to view the numbers well. I've moved them to this link here that should be viewable. https://drive.google.com/drive/folders/1s8xCF2U1H0olsUV8ojErttBO-jYw3o2n?usp=sharing

P.S., he free feeds/grazes. He is on a low-carb wet food mostly but I leave Purina DM dry down for him, which he eats a few times a week but isn't his go-to food source.
 
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I have added the info from the libre to the spreadsheet. Hopefully you can see it. I'm using the second tab of it. I didn't input all the numbers, but I put where he had notable changes. The screenshots on the link in my post will show you the curve for the days. I haven't included screenshots since 6 April but can upload them if they'll be useful.
 
I’m perplexed as to why the morning and evening preshot tests numbers (Libre scan) is the same every day. It says 486 every day. Could you also fill in the units column with the number of insulin units given each day (there are a few missing.)
 
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I don’t think we have talked about his feeding schedule. I know you said that he free feeds, but this is not necessarily the best for a diabetic cat - although some modified free feeding can be tried.

It’s important that he not have anything to eat for two hours prior to the AMPS and PMPS tests (Libre scan.) This is so that you will get an accurate fasting BG on him and the number will not be inflated because of food. This way you can see if it is safe to shoot insulin or if a reduced dose should be considered or even, potentially, a skipped dose.
 
I would pick a dose and stick with it- holding for 7 days unless he drops below 90 or if you get a very low preshot number. There have been too many changes in his dose in the last few days - well I am also assuming that 3.5 units were shot where there is nothing in the cell for units. If so, then it looks like you will have completed 4 of the 7 days after today April 13.
 
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I still want to ask more questions about when he eats. Is he grazing during the early portion of the cycles. We frequently recommend feeding snacks in the early portion of the cycle. (+1, +2,3,4 etc.) but do not recommend feeding after nadir because it can shorten the duration of the insulin by causing numbers to rise when the insulin’s effect is not as strong as it was earlier in the cycle. His nadir seems to be moving around a bit right now so I would just say not to let him eat after +6 for the time being. If he ate some low carb wet food at +6 that would probably be okay and then just feed him in the evening right after you scan the Libre and record the fasting BG number.
 
The Libre stops reading at numbers over 27.8 mmol. I'm not able to do ear/par pricks on my own with him, unfortunatenly. Anything over 27.8 mmol the libre will display as "HI". So I just cap him at 27 as he's been either at 27 or "HI" every pre-shot until today (!!) where his pre-shot was 20 mmol! I moved his dose to 3.50 after my initial post here as that felt like a safe zone to avoid hypo again. I filled in the empty spots on the spreadsheet (they were 3.5). I'm using the world tab, presumed it would've pre-populated the US tab but it looks like it didn't on those ones for whatever reason.

I've taken up his Purina DM dry food about 3 days ago now so he's been on less than 5% carb wet food (with the occasional Gourmet Cat thrown in at 9% carb), with the occasional freeze-dried meat treats. I leave this low carb wet food for him at night as well to avoid him harrassing me while sleeping. He has been eating about 2-3 hours pre PM shot. I didn't realise the feeding schedule would impact the insulin like this. I was scrolling through this message board yesterday and saw a thorough response you made to someone about feeding as well so yesterday I took his food up and he didn't have anything from his nadir until his PM shot, and those are the best numbers he's had for quite a while. Today, I'll "feed" the curve to try to help stabilise it in the morning then take his food up again this afternoon. I'll also hold the 3.5 until I see his nadir or pre-shots drop per your feedback above. I can't control what he does overnight, but this morning I feel much more encouraged than I have done previously. Thank you so much for your invaluable support and advice!

**EDIT** looks like he's hit 3.5 mmol about 5 hours after his AM shot today. I'll see how he goes today and look at possibly reducing to 3.25 this evening since he's dipped below 90 mg but I may hold this dose for a little longer to complete the 7 day cycle.
 
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I'm glad to be of help and I'm glad that you poked around to find some other posts where I've explained things. I didn't want to push too much about feeding until I found out a little bit more about what your schedule is like or what kind of feeding you are able to do. And I didn't want to overwhelm you, but looking at his SS last night I definitely felt like I needed to know when/what he was eating in order to make sense of the numbers.

Now I recall you talking about the Libre reading Hi!
 
So I hope you gave him a snack when he hit 63. Just a low carb snack should have been adequate and then you could scan him again in about 30 minutes to make sure his BG was rising or flat.
 
And since he hit 63 today then he has earned a reduction to 3.25 units per the SLGS (Start Low Go Slow) protocol. He may bounce a bit so don't be surprised by higher numbers later today or tonight (and we will see for how long after). Be encouraged! He's starting to make some progress. I'm happy with that. Feline Diabetes is such a marathon!

I don't know if you have had a chance to read about the dosing methods for ProZinc on this forum. They are in the sticky notes.
 
Thank you! I did give him a light low-carb snack. He started coming back up a few mins after to 5 and is around 7 about an hour or so after the 5. Annoyingly, the app that the Freestyle Libre uses can be very tempramental on Android and it won't give me an updated scan as of right now, but about an hour ago he was at 7. His PM shot is due in about 3.5 hours so he won't be grazing til his meal at shot time.
 
You are doing great! You're so far ahead of me! I'm only at 10:47 in the morning. Did you tell me you were in the UK? I can't remember if you said. At least I'll still be awake to peek and see how he does at PMPS and this evening. I have heard about people having trouble with reading their Libres and it tells them that they have to wait a certain number of minutes to re-scan. It can be a problem in a hypo situation. Well, and actually now that I think of it, it has been a problem because sometimes you have to retest every 20 minutes after administering high carb or karo. Also, I have found that the Libre sensors tend to read lower in the lower numbers. When helping someone with an extended (24 hour) hypo from an overdose (vet did it) we found that the Libre was giving lower readings than the ear prick.

Anyway, let's keep your baby out of hypo range and we won't need to worry about that. I do wish you could ear prick him though to see what his number would have been on a human meter when he hit 63 on the Libre today. But if you can't do it yet, then you can't do it. Is he fractious?
 
Thank you for the support. I'm really trying. I'm kind of amazed at the general lack of support/treatment options that are given to cats/owners by many professionals regarding this diagnosis. This resource is honestly priceless. I can only hope every person who feels lost with a diabetic cat can find their way here.
I am based in the UK. His last libre, which finished a few days ago, worked absolutely perfectly. It really highlighted to me the value of them but, yes, when they don't work they are a nightmare. My boy is a very docile, friendly and lovable soul until you start touching his ears and feet. He really isn't into it. He hates his ears being pet and his feet touched. He's so fearful in the vet he just sits there and they fold his ear back to prick him rather than the "sweet spot" and he cries. But when I try to go for his ears in any fashion at home, he runs away. I've managed 1 successful glucose read from him from the meter I have, and I took that sample from the shaved part of his side where a previous libre was fitted. I have since tried literally over 30 times and I either haven't drawn blood or he's run away before I can even put him on the "testing station" I made for him with treats and everything. Once he grabbed the treats then darted off before I could even begin! If I had someone to hold him, it would help a lot but my partner works super long hours so most of the care is left for me to do as I work from home most of the time.

I know in a human you should always cooberate a low reading with the glucose meter. I've been looking online/this board for any other ways to get blood from him that won't hurt him/freak him out. I just don't know what I'm supposed to do with a cat who really hates those spots for blood to be touched at any given time letalone with a sharp object. He's generally good with his shots but even then sometimes he just isn't in the mood for being stuck with things and will cry and move as soon as he feels the needle.

I'm still undecided if I should lower his dose .25 or hold at 3.5. I know SLGS instructs to reduce the dose but not sure if this is just an anomoly as I don't want to flutcuate his dosing a lot. This disease really is tricky to navigate!
 
mariec22 said:
Thank you for the support. I'm really trying. I'm kind of amazed at the general lack of support/treatment options that are given to cats/owners by many professionals regarding this diagnosis. This resource is honestly priceless. I can only hope every person who feels lost with a diabetic cat can find their way here.
I am based in the UK. His last libre, which finished a few days ago, worked absolutely perfectly. It really highlighted to me the value of them but, yes, when they don't work they are a nightmare. My boy is a very docile, friendly and lovable soul until you start touching his ears and feet. He really isn't into it. He hates his ears being pet and his feet touched. He's so fearful in the vet he just sits there and they fold his ear back to prick him rather than the "sweet spot" and he cries. But when I try to go for his ears in any fashion at home, he runs away. I've managed 1 successful glucose read from him from the meter I have, and I took that sample from the shaved part of his side where a previous libre was fitted. I have since tried literally over 30 times and I either haven't drawn blood or he's run away before I can even put him on the "testing station" I made for him with treats and everything. Once he grabbed the treats then darted off before I could even begin! If I had someone to hold him, it would help a lot but my partner works super long hours so most of the care is left for me to do as I work from home most of the time.

I know in a human you should always cooberate a low reading with the glucose meter. I've been looking online/this board for any other ways to get blood from him that won't hurt him/freak him out. I just don't know what I'm supposed to do with a cat who really hates those spots for blood to be touched at any given time letalone with a sharp object. He's generally good with his shots but even then sometimes he just isn't in the mood for being stuck with things and will cry and move as soon as he feels the needle.

I'm still undecided if I should lower his dose .25 or hold at 3.5. I know SLGS instructs to reduce the dose but not sure if this is just an anomoly as I don't want to flutcuate his dosing a lot. This disease really is tricky to navigate!
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If it were my cat i wouldn't lower. You test often and are pretty on top of the numbers.
 
My experience with testing started with a growling Newman determined not to allow me to treat him. With some good advice from a friend and a little bit of luck, I was able to turn that around. I'm hoping that you may find my experience useful.

My friend suggested that I offer him a treat at the location I had chosen for testing and not do anything to him, just give the treat and pet him, briefly touching his ears and gently pinching and releasing the scruff. After just a few times of doing this, he changed from a growling cat to one who shows up at test and treat time almost like clockwork. I also found that the less I restrained him, the more he was willing to stay still.
 
I’m glad you took the reduction. I see you had a lovely green today. I’m very pleased to see this. Thanks for keeping the spreadsheet updated so we could see this. I love it.
 
Thank you all for support and advice. I think he might be in a bounce today from a couple lows but will hold dose for a few days and see how it goes.
 
Good afternoon (morning for me!) He’s doing really well on this dose. Last night looks good. He gets back to work pretty quickly after the lows (he goes high for a short while but then starts coming back down.). I’ll look at his spreadsheet later today and I hope that will be the case.
 
Wow, Marie! I was just checking in on Nacho's spreadsheet. I see you've had your ups and downs lately. Congratulations on the reductions. You've been managing things well from the looks of it.
 
I need to inform that my beloved passed away yesterday unexpectedly, and not due to diabetes. He lost ability to lay down and was limping, yowling and in pain. His legs have been an issue for quite a while. Vet advised temporary measures but taking his age and prognosis into consideration, said we would likely be back in this situation in a few days. We chose to not let him suffer more than needed. We are utterly heartbroken. He almost passed in Decmener, how all of this started, and he hadn't really ever fully recovered. I hate this decision, and am deep in grief right now but maybe in time it will all make sense but right now I just want my boy back.

Thank you for your support and kindness. This is a special place and I am glad that my cat did benefit from the advice and many others will as well. Take care.
 
mariec22 said:
I need to inform that my beloved passed away yesterday unexpectedly, and not due to diabetes. He lost ability to lay down and was limping, yowling and in pain. His legs have been an issue for quite a while. Vet advised temporary measures but taking his age and prognosis into consideration, said we would likely be back in this situation in a few days. We chose to not let him suffer more than needed. We are utterly heartbroken. He almost passed in Decmener, how all of this started, and he hadn't really ever fully recovered. I hate this decision, and am deep in grief right now but maybe in time it will all make sense but right now I just want my boy back.

Thank you for your support and kindness. This is a special place and I am glad that my cat did benefit from the advice and many others will as well. Take care.
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Omg I'm so sorry. That's heartbreaking.
 
mariec22 said:
I need to inform that my beloved passed away yesterday unexpectedly, and not due to diabetes. He lost ability to lay down and was limping, yowling and in pain. His legs have been an issue for quite a while. Vet advised temporary measures but taking his age and prognosis into consideration, said we would likely be back in this situation in a few days. We chose to not let him suffer more than needed. We are utterly heartbroken. He almost passed in Decmener, how all of this started, and he hadn't really ever fully recovered. I hate this decision, and am deep in grief right now but maybe in time it will all make sense but right now I just want my boy back.

Thank you for your support and kindness. This is a special place and I am glad that my cat did benefit from the advice and many others will as well. Take care.
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Oh Marie! This is such heartbreaking news. I am so deeply saddened to read this, and I feel so deeply for you. I know what this is like and what a tremendous tearing of the heart and such an emptiness that there is after this happens -- and how you question everything. I am so very very sorry.
 
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