Dosing Advice

Looking at his spreadsheet, it does appear that he achieved better numbers on the 1.5 unit dose. I would agree that — excepting an unexpectedly low pre shot test — he can get 1.5 units. Ideally, you should keep him on this dose for 7 days so that things can stabilize and we will really know how things are going on that dose. Obviously, if Freddie decides to get up to shenanigans, you may have to adjust things. I hope not.
 
I was thinking the same thing, however, we may not be seeing quite the full effect of transitioning to LC dry recently and the changing doses the last few days may be making numbers a little wonky too, but Mimi tests enough to catch any lower numbers.
 
Yes, I would like to ask about the food situation now. What is Freddie eating now? We had talked about a gradual food transition. Where does that stand? Is he completely transitioned to low carb food now? You also said he prefers wet food over dry.
 
I think it was because of a recommendation from the Feline Diabetes Support Group on Facebook’s team suggested it…. I had got home from work on Thursday and his PMPS was low….
 
Suzanne & Darcy said:
Yes, I would like to ask about the food situation now. What is Freddie eating now? We had talked about a gradual food transition. Where does that stand? Is he completely transitioned to low carb food now? You also said he prefers wet food over dry.
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He is eating 90% low carb wet food. 10% of the time he may nibble on the dry which is almost completely transitioned to Dr Elsey’s .
 
But I saw that Thursday night he got two units. So I was confused to see the 1 unit after that. But anyway never mind. You are monitoring his progress really well! So you want to move forward with the 1.5 unit dose?
 
Suzanne & Darcy said:
But I saw that Thursday night he got two units. So I was confused to see the 1 unit after that. But anyway never mind. You are monitoring his progress really well! So you want to move forward with the 1.5 unit dose?
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Yes, I think so… Do you think 1.25 would be a wiser choice? The reason I gave 2 units was on the advice of his veterinarian.
 
If you would like to try the 1.25 unit dose first, then that’s fine. Normally, we recommend dose changes be made in .25 increments — although there are circumstances where nadirs are above a certain level and .5 increments are warranted. The only reason why I said that 1.5 would be okay is that he was previously on doses of both 1.5 and also 2 units. The last two days were 1 unit only, but he wasn’t getting good numbers on that — and the dose reduction seemed to be just a temporary reduction that I wanted to ask you about. So, I am okay with the 1.5 dose because you do so much testing. If you are nervous about going back to 1.5 then I am perfectly happy with you trying 1.25 units for 7 days too. It’s really all dependent upon your ability to get tests in and your comfort level. If you are testing, you are in control.
 
Suzanne, thank you so much for your time and advice! I think I might go ahead with the 1.25 this morning and monitor his progress. Freddie is so easy to test now, when he hears the microwave going when I warm up the rice sock he comes to the counter for his test and treat! The treat is freeze dried chicken.
 
MimiG said:
Suzanne, thank you so much for your time and advice! I think I might go ahead with the 1.25 this morning and monitor his progress. Freddie is so easy to test now, when he hears the microwave going when I warm up the rice sock he comes to the counter for his test and treat! The treat is freeze dried chicken.
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That is so good to hear. I was thinking that you had the testing thing down pat because your spreadsheet looks so nicely filled in. It’s really a blessing to have a cooperative cat! He likes those treats. :). My boy was so easy to test and never gave me a hard time. You are very welcome.
 
I see you got a nice green and then blue today for Freddie. Very good. I hope it wasn’t scary. That 88 is a safe green number and is in the normal healthy range for a cat. He is still diving down faster than I would like to see in the first two hours of the cycle. Make sure to give a +1 snack and a +2 snack of a heaping teaspoon of wet food. If that doesn’t slow his rate of drop, increase the carbs in the snacks for the very early part of the cycle. Steep drops can definitely trigger bounces. Good night.
 
MimiG said:
@Suzanne & Darcy Do you think it’s too soon to go ahead and increase Freddie’s dose to 1.5 tonight based on his numbers the past few days on 1.25?
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How about doing it tomorrow morning? That way he's been on that dose for six cycles. Would that be okay? I know it's so hard to see him in higher numbers. Then you should probably say that you are doing the MPM (modified prozinc method) which allows the more rapid dose adjustments. You can always switch back later on.
 
I'd hold the dose longer. He's coming off that green and now that fast steep 60% drop 03/13 AM cycle. They tend to bounce harder when the bounce drop is more than 50% from preshot to nadir, and that drop was brutal - over 50% within 2 hours. And, as a reminder, if you're still feeding any amount of dry, SLGS should be followed. Marje & Gracie addresses it in Post#4 & #6 in this thread: https://felinediabetes.com/FDMB/threads/would-like-opinions-on-dosages.254248/
 
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Shelley & Jess said:
I'd hold the dose longer. He's coming off that green and now that fast steep 60% drop 03/13 AM cycle. They tend to bounce harder when the bounce is more than 50% from preshot to nadir, and that drop was brutal - over 50% within 2 hours. And, as a reminder, if you're still feeding any amount of dry, SLGS should be followed. Marje & Gracie addresses it in this thread: https://felinediabetes.com/FDMB/threads/would-like-opinions-on-dosages.254248/
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Ooohhh... you're right about that dry food!
 
Shelley & Jess said:
I'd hold the dose longer. He's coming off that green and now that fast steep 60% drop 03/13 AM cycle. They tend to bounce harder when the bounce is more than 50% from preshot to nadir, and that drop was brutal - over 50% within 2 hours. And, as a reminder, if you're still feeding any amount of dry, SLGS should be followed. Marje & Gracie addresses it in this thread: https://felinediabetes.com/FDMB/threads/would-like-opinions-on-dosages.254248/
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But he dropped into the yellow today - then back up to pink — so I think he already broke the bounce from that brutal drop - of course he may go boing again.
 
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And I definitely feel like a broken record, and I forget who I have asked this of... but you are feeding some snacks in the early part of the cycle... +1, +2, etc.? He drops early and we would like to smooth this out.
 
I did also want to say that when you are getting blue and green nadirs on a dose, we recommend holding them a bit longer - even when following the more aggressive dosing methods. I just feel sorry for you seeing him in the higher numbers so I think I am almost as anxious as you are to increase.
 
Suzanne & Darcy said:
How about doing it tomorrow morning? That way he's been on that dose for six cycles. Would that be okay? I know it's so hard to see him in higher numbers. Then you should probably say that you are doing the MPM (modified prozinc method) which allows the more rapid dose adjustments. You can always switch back later on.
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I gave him 1.25 tonight and was going to give him 1.5 tomorrow morning but now I see @Shelley & Jess feels I should hold it longer.. Freddie really doesn’t eat much dry food at all - it’s Rufus who prefers the dry. It is almost 100% Dr Elsey’s dry right now too.
 
Suzanne & Darcy said:
And I definitely feel like a broken record, and I forget who I have asked this of... but you are feeding some snacks in the early part of the cycle... +1, +2, etc.? He drops early and we would like to smooth this out.
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Yes, he has a total of 3 cans of a mixture of Fancy Feast, Dr Elsey’s canned, or Wellness pate canned.
 
MimiG said:
Yes, he has a total of 3 cans of a mixture of Fancy Feast, Dr Elsey’s canned, or Wellness pate canned.
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But at what time (+ what hour?) is he eating this food? I’m only asking because I am trying to figure out how to prevent steep drops. We may have to consider some slightly higher carbs at various points in the cycle (early).
 
He eats in the morning 9:30 Am and then at midday, and then at 9 :30 pm . He eats a good portion of it but not all of it at once. I leave it out for him to graze.
 
I just opened him a fourth can as he finished his 3rd can completely and was waiting for more! This is one hour after his pm insulin shot.
 
MimiG said:
I just opened him a fourth can as he finished his 3rd can completely and was waiting for more! This is one hour after his pm insulin shot.
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That’s good. See on his spreadsheet how he frequently has a huge drop by +2. If you spread his morning or evening meal out a bit by giving him a teaspoon or two at +1 and again at +2 then it could really help prevent steep dives. The steep dives trigger bouncing so that’s why we want to smooth out the cycle. And then we don’t recommend feeding after nadir because it can shorten the duration of the insulin — you can end up with a higher preshot number.
 
Suzanne & Darcy said:
That’s good. See on his spreadsheet how he frequently has a huge drop by +2. If you spread his morning or evening meal out a bit by giving him a teaspoon or two at +1 and again at +2 then it could really help prevent steep dives. The steep dives trigger bouncing so that’s why we want to smooth out the cycle. And then we don’t recommend feeding after nadir because it can shorten the duration of the insulin — you can end up with a higher preshot number.
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I gave him 1.5 this morning and his AMPS was 19. I gave him some more canned FF - he ate about a tablespoon or two at +1. I just checked his BG at +3 and it was the 14.2. So not as steep of a drop!
 
Yes the 1.25U should have been held a little longer given the 88, but I wouldn't backtrack right now since I'm seeing this late - just be careful. The increase to 1.5U may be enough to get him close to 50s
 
Be sure to give the snacks tonight! It seems to be helping. I’m :nailbiting: about the yellow preshot as he hasn’t had one in a while. And you are already planning the before bed test so you can handle anything that may arise.
 
He looked like he was headed into the blue last night since your before bed test was 202. I probably would have given a small low carb snack of wet food at that time before I went to sleep. I hope things will be looking good this morning.
 
I think I will do a curve on Freddie today. His numbers seem to warrant an increase in dose, I suspect? I would appreciate any thoughts.
 
Shelley & Jess said:
Melissa (@FrostD) is an absolute whiz at visualizing cycles on a spreadsheet and I see this one too - concerned about the possible blues we're not seeing.
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I’m not sure what this signifies being a newbie at this! I thought that because we’re not seeing much blues that the dose should be increased?
 
The only blue we’ve documented on this dose is a very high blue and that was at +6 on March 16. I am skeptical that he had a super low blue that day at +4 or +5. At +3 he was mid-yellow. On this dose, Mimi has implemented feeding the suggested snack early in the cycle which have prevented his former early drops. Today his +4 is still yellow.

You still will have to wait until March 22 to do an increase, but if things continue along as they are now, I would have no problem with a .25 increase. But you never know what those last few days may bring. He is making some progress. I hope he’s feeling and acting happy.
 
MimiG said:
Yes, Freddie is feeling and acting fine. He is still pretty ravenous inhaling about 3-4 cans daily.
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I agree with Suzanne he could have posiby dropped on the day in ? I would hold the dose longer so your not accidentally missing the right dose. Him wanting to eat & eating well could be he's dropping & he's seeking to eat food to bring his numbers back up sometimes so high that we think increase when that might be saying decrease instead. I would get in as many tests as you can, try to catch a possible low. If you look at Panzer's spreadsheet, I'm an over tester LOL called a test aholic.:smuggrin: that's my thoughts but I'm no expert. I would love some more input on Freddie's spreadsheet from other members :cat:
 
Ok given that you will want to continue to hold, that's a good nadir. Not much wiggle room to increase.

Glad my crystal ball is functional!
 
If you could cut out the dry food then you would be able to get him into a little better numbers. But I know we’ve talked about this before and I know he doesn’t eat very much. Anyway, hopefully he will become less bouncy over time because I hate seeing the higher numbers on his spreadsheet.
 
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