Help - new - stalling on shot

D & Nacho

D & Nacho

Member
Hi, new to the forum, have a couple days of data on Nacho, but he's been wearing the Libre Freestyle3 for 9 days. No real patterns yet... he's kinda all over the map.

I've been stalling for an hour to get him up to a shootable number. How long after the usual shot time do people call it and just skip the dose? 2 hours? 3 hours?
 
As far as when to completely skip the dose, that depends on how badly your next day’s schedule will be impacted. I am assuming you have not fed him yet? When stalling it’s important not to feed them. He hasn’t really budged from his PMPS after 1 hour. If you can monitor the cycle tonight for a while or wake up to check his Libre numbers, I would just shoot 1 unit. That probably won’t be enough insulin but may keep him from going too high. Then we can see and have a better idea next time and try a little bit larger dose — until we gather data on what happens.
 
Thank you! I think we're going to try .5 just to be safe, because his declines tend to be really sharp and we're worried about a third near hypo event this week (that happened pre-spreadsheet)

Technical question; we typically shoot at 5:30pm, now the shot will be at 7:30pm. Do we record the 7:30pm number as the PMPS, so that the +1, 2, etc, are still reflective of the hours AFTER the shot is given? In this case, the data between 5:30-7:30 would not be recorded on the spreadsheet.

OR, we still stick with recording the PMPS number as 5:30pm just so the columns are all consistent with the actual times of day?
 
Okay. I understand. At least you will see how he responds to that very small dose. The insulin won’t kick in for about two hours, so he still has time to come up — and I see he has a habit of doing just that and keeping on going into the high numbers. How low did he go this week before the spreadsheet? You’ve got to watch the Libres when they record low numbers. They tend to read way too low, we find, with numbers below 100. You really need a hand held human meter to back check the Libre when there’s a concern about a number that’s too low. As for the spreadsheet, you’re supposed to record all the numbers in the cell. You just kind of jam them in there. Put the first number then the next one, and write +13 in that same cell for PMPS.
 
So you would have 133 and 139 and 141 all in the same cell (PMPS) and you have to manually color code the cell (blue in this case.)
 
Thanks! I think I have the spreadsheet right now. That was a mind bender for someone who's not good at math and graphs lol! We'll have to get him back to 5:30/5:30 schedule, but luckily we have flexibility to do that slowly over the weekend pending his numbers... I'll have to think really hard about that when it happens too!

The lowest reading I've gotten on the Libre is 50. I started taking action each time around 90 because he drops (and rises) so quickly. We're going to order the test strips etc and will start him on them next week. We have one more Libre and may use that for a second round if he's still not super stable by the time this one expires in 5 days.

And yeah, he's pretty cute, thanks! That shot was pre-diagnosis and pre-lion's cut; he's a lot smaller now due to the weight loss and the major hair cut!
 
I was just checking out your notes. I just wanted to mention that the Libre sensors are known for giving inaccurate readings when they are brand new and when they’re about to die.
 
Thanks Suzanne! I was going to reach out and see if you had any suggestions based on Nacho's data. We just can't seem to get him to stick in a decent range. We were able to pick up the Relion stuff this weekend and our vet tech is coming over tonight to show us how to use it so we can compare it to the Libre. We are planning to keep the Libre on him as we have guests coming and aren't going to be able to do multiple tests per day with the Relion for the next week and a half.
 
Please don’t go down to 2 units to “stabilize the bouncing” it won’t work - that’s just not how it works. You need to hold this 3 unit dose for now and put up with the bouncing. He had a fantastic string of greens the other night. And then, of course, the inevitable bounce. I know how incredibly frustrating it is, but the only way to stop the bouncing is to allow him to get used to being in lower numbers. It takes a while sometimes.
 
Last edited:
See how he cleared the bounce in the fourth cycle after the greens? The indication that he was about to clear the bounce is that he had that string of flat yellow numbers. A string of flat yellows often means a bounce is going to clear. Bounce can last up to SIX cycles so be glad that Nacho is clearing them faster than that. He will have opportunities more often for his body to get used to lower numbers. He didn’t become diabetic overnight and he won’t get regulated overnight. It takes time— but y’all are on the right path!
 
Last edited:
Shoot, our vet is really insistent on going down to two units to stabilize the bounce then go back up from 2 to 3 incrementally at the quarter or half dose; they suggested holding at 2 units for at least 2 weeks.
 
As you can see from your Libre readings, 2 units is totally the wrong thing to do for Nacho. It’s hurting him. Holding the dose for two weeks in those high numbers is crazy. He will get glucose toxicity and his numbers will be even harder to control. I hope you are testing for ketones. He could be in danger of developing DKA in those continually high numbers. I am sure the vet means well, but he/she is not a professional at managing feline diabetes. He was at least making progress before, even if bouncy. The only way to reduce bouncing is to get the cat to spend more time in lower numbers. This dose is doing exactly the opposite- getting him to remain comfortable in high numbers. I am really sorry to see this.
 
See what happens today and tonight. He’s not getting enough insulin. You could go back up to 2.5 units tomorrow. He’s been spending most of his time in a bounce lately. We need to get him lower at least for a while. Is he gonna bounce again? Most likely yes, but it’s a process that you have to go through. We all hate bounces. Sometimes it seems like you will never make any progress. Just ask @Shawn & Sir Maximus right, Shawn? I hope you don’t mind me tagging you again to help another member. Shawn’s cat, Sir Maximus went through a long period of time where he bounced every time he hit a blue or green number. Just one blue or green would send him into pink or red by the end of that cycle. Sir Maximus now is spending most of his time in green on a dose of only .25 units.

Look at Sir Maximus’ spreadsheet for last year and for this year @D & Nacho .

https://docs.google.com/spreadsheet...X5fH86twjISK-BDQhv_B7J-s2gpeXeOmSTELX/pubhtml
 
Suzanne & Darcy said:
See what happens today and tonight. He’s not getting enough insulin. You could go back up to 2.5 units tomorrow. He’s been spending most of his time in a bounce lately. We need to get him lower at least for a while. Is he gonna bounce again? Most likely yes, but it’s a process that you have to go through. We all hate bounces. Sometimes it seems like you will never make any progress. Just ask @Shawn & Sir Maximus right, Shawn? I hope you don’t mind me tagging you again to help another member. Shawn’s cat, Sir Maximus went through a long period of time where he bounced every time he hit a blue or green number. Just one blue or green would send him into pink or red by the end of that cycle. Sir Maximus now is spending most of his time in green on a dose of only .25 units.

Look at Sir Maximus’ spreadsheet for last year and for this year @D & Nacho .

https://docs.google.com/spreadsheet...X5fH86twjISK-BDQhv_B7J-s2gpeXeOmSTELX/pubhtml
Click to expand...
Yes I can definitely relate to all those bouncing cycles. It was very frustrating and I didn't think I was ever going to keep him in low numbers. It takes time and alot of patience and determination but hopefully soon he will adjust to being in lower numbers and the bounces will subside. I couldn't of done it without Suzanne's help and guidance. Good luck and feel free to reach out anytime
 
How is Nacho doing by the way? How is he feeling? Is he eating a lot of food? Is he handling the houseguests okay? I know you said you were going to have guests for a while. I hope he’s not stressed out.
 
Hi @Suzanne & Darcy and @Shawn & Sir Maximus! Thank you so much for looking out for Nacho. Our house guests have taken off and it wasn't stressful for Nacho at all; they all know and love each other quite well.

Nacho's been pretty consistent in terms of energy level, food/water consumption, and litter box habits... he's not awesomely spunky but he definitely doesn't seem sick, in pain, or stressed. Just kinda meh. Still cuddles and wants attention but is not playful and sleeps a lot.

If you check the spreadsheet you'll see that we have incrementally increased him from 2 to 2.25 and as of yesterday, 2.5.... against the vet's wishes but here we are.

We'll hold at 2.5 for at least 6 cycles then would love to have you weigh in! Vet mentioned possibly moving him to another insulin but didn't give a reason why. We're on a brand new bottle that should last him through early August so I'm hopeful we can get him stabilized on the current ProZinc vs switching now and starting all over again.

Thoughts?
 
Sounds like a plan! I will be happy to take a look.
What do you do for his IBD these days since he’s no longer on Prednisolone? How do you control inflammation?
 
The diet change and insulin has eliminated all symptoms of IBD; the vet suspected that might happen. We were weaning him off of the steroids prior to his diabetes diagnosis as he was basically down just a furball or two per month. Now, it's super rare to even have a furball (the lion's cut helps a lot with that too!)
 
@Suzanne & Darcy - we've only seen a little improvement since the dosage increase -- do you think it's time to go up to 2.75 or is it too early? Isn't the rule of thumb to hold an increase for at least a full week?
 
Hold off on the increase. Here’s why: he had green nadirs the evening of June 10. In fact, a great cycle. He’s been bouncing since then and we need to give him time to clear the bounce so he can get back into lower numbers. I fear if we increase now and he breaks the bounce it would drop him too low. Bounces can take up to 6 cycles to clear so he should be clearing it soon … perhaps today.
 
Thanks for the advice! He's barely gone below 400 since the 10th so I'm getting antsy. We'll hold steady and hope for a clear tonight (that'll be the 6th dose) or tomorrow
 
Yes, because we can’t increase his dose when he’s having nadirs that are green like that. Hopefully he will clear it and get back down into blue and green again. If we increase when he’s already seeing green then the new/increased dose will likely drive him too low (when he’s not bouncing) and we don’t want any lime green. I only wish that we could verify those green numbers with a handheld human glucometer. Perhaps next time. The Libres can read too low in those lower numbers. But so far I am encouraged that he can get into low/normal numbers even though his body is currently perceiving this as a threat and bouncing.
 
so actually during the green hours on 6/10, in real time the Libre read in the 50s and 60s, so I was with him and giving snacks. The Libre changed the numbers at some point over night, as my husband recorded those numbers in the morning around AMPS time. It's done that before; read low in real time then finalize numbers 10-20pts higher.
 
D & Nacho said:
so actually during the green hours on 6/10, in real time the Libre read in the 50s and 60s, so I was with him and giving snacks. The Libre changed the numbers at some point over night, as my husband recorded those numbers in the morning around AMPS time. It's done that before; read low in real time then finalize numbers 10-20pts higher.
Click to expand...
Wow. That is weird. I haven’t heard that before. We usually recommend that people do a manual test to check the BG value — often it’s higher. So the numbers you recorded on the spreadsheet were the revised Libre numbers from the morning?
 
Suzanne & Darcy said:
Wow. That is weird. I haven’t heard that before. We usually recommend that people do a manual test to check the BG value — often it’s higher. So the numbers you recorded on the spreadsheet were the revised Libre numbers from the morning?
Click to expand...

Yes, those were the revised numbers... in real time the numbers displayed on the Libre app were lower. We did a Relion test today at +11 to see what "HI" was and the Relion read 318 ... so that actually gave us some relief that he wasn't off the charts, but it didn't make us feel great about the Libre numbers. Problem is that Nacho really doesn't tolerate the ear prick so I'm reluctant to do it very often.

We got to test his ketones today too; he's ok at .5. Phew... but will test again next week if his baseline isn't lowering
 
Hey. How’s it going with Nacho. Who is Taco? I see Taco eats kibble. Are you absolutely certain that Nacho isn’t eating kibble?

You have had some green nadirs. That means you should hold the dose. The Libre sensors are well known for giving wacky numbers at the beginning of a new sensor ad when they are about to stop working. Could that be happening? When you get green numbers it would be really really good if you could do a manual test to see what your handheld meter says.
 
Hi, thanks for checking in! The green nadirs on 6/20 were definitely false... according to my husband (I've been out of town) the sensor was hanging on by a literal thread then fell off. We've held 2.75 units for 9 days now and think it's time to go up to 3 units. He had started responding to 3 when the vet told us to reduce to "eliminate the bounce"...

We've failed every time with a manual test. Haven't gotten Nacho to allow it for long enough to draw sufficient blood. We're still trying!!

Taco is Nacho's littermate. Taco has a feeder that only opens for his microchip so yes, we are certain Nacho is not eating his kibble. Plus Taco eats EN Purina at 12% carbs and is being transitioned to Dr. Elsey's just to be safe. He gets his carb in hand held treats only.
 
I agree that since we can disregard the greens on that day — he should go back up to 3 units. That’s so cute! Taco and Nacho! Do they look alike? I’m so glad you have the microchip feeder.
 
Thanks! We'll start him tomorrow on 3 units -- he tends to be lower at night so better to be able to monitor the increase while we're not trying to sleep.

Taco is just as fluffy but he's brown, black and white. He's quite handsome :)
 
D & Nacho said:
Thanks! We'll start him tomorrow on 3 units -- he tends to be lower at night so better to be able to monitor the increase while we're not trying to sleep.

Taco is just as fluffy but he's brown, black and white. He's quite handsome :)
Click to expand...
I always like to do increases in the morning too. I would like to see Taco and Nacho too.
 
Suzanne & Darcy said:
Hold steady. Sometimes when increasing the numbers will go higher for a little while. We call it new dose wonkiness.
Click to expand...
My understanding is that this doesn't apply to Prozinc (or Vetsulin)
https://felinediabetes.com/FDMB/threads/do-daas-pz-dosing.221698/page-2#post-2493252
I don't mean to cause confusion or anything, but, would hate for a caregiver to look for something/see something that's not really there. :)
@Marje and Gracie can you expand at all on your past post for us please?
 
Shelley, nice to “see” you! It’s been a while.

Maybe not about the NDW. But I saw this in my own cat. Thank you even with ProZinc. Of course he had acro. But that is what happened.
 
Last edited:
Shelley & Jess said:
My understanding is that this doesn't apply to Prozinc (or Vetsulin)
https://felinediabetes.com/FDMB/threads/do-daas-pz-dosing.221698/page-2#post-2493252
I don't mean to cause confusion or anything, but, would hate for a caregiver to look for something/see something that's not really there. :)
@Marje and Gracie can you expand at all on your past post for us please?
Click to expand...
I’m sorry for the delay in response….I’ve been out of town.

We don’t really know why NDW occurs in cats on the depot insulins but it’s not something we see in the non-depot insulins. If we knew exactly why it occurs in the depot insulins, it might give us a clue as to why we don’t see it in the non-depots. We’ve had discussions as to the possibility the liver responds differently when the dose is increased with a depot insulin but it’s just speculation.

I’m sorry I can’t provide a better answer.
 
You must log in or register to reply here.
Back
Top