Help with Dosing (Partial Continuation)

[Shwayna]

This is a partial continuation from my post: Extremely Soft Stool Problems

Tagging @Suzanne & Darcy (if the tag works)

Jojo's dosages were decided by his vet. She advised that I adjust doses if needed, but on a daily basis, such as adjusting AM shot to 2u if needed, PM to 1u if needed, etc. I realize I should've come and asked for advise, so I apologize. She is no longer helping me out, and has basically told me good luck and to make an appointment if I need something in regards to Jojo's diabetes. As Jojo's PMPS was at 113, I decided to stall shooting. He is at 185 at +1, but even at 185 I haven't shot 3u, instead (stupidly) following my vets advise of adjusting his dose based on what his BG is at.

 

[Suzanne & Darcy]

Hi Shana!

 

[Suzanne & Darcy]

This is a partial continuation from my post: Extremely Soft Stool Problems

Tagging @Suzanne & Darcy (if the tag works)

Jojo's dosages were decided by his vet. She advised that I adjust doses if needed, but on a daily basis, such as adjusting AM shot to 2u if needed, PM to 1u if needed, etc. I realize I should've come and asked for advise, so I apologize. She is no longer helping me out, and has basically told me good luck and to make an appointment if I need something in regards to Jojo's diabetes. As Jojo's PMPS was at 113, I decided to stall shooting. He is at 185 at +1, but even at 185 I haven't shot 3u, instead (stupidly) following my vets advise of adjusting his dose based on what his BG is at

Okay. That explains the wonky dosing. It’s okay. We all try to do our best and if the vet is telling us stuff we usually rely on that.

 

[Shwayna]

Okay. That explains the wonky dosing. It’s okay. We all try to do our best and if the vet is telling us stuff we usually rely on that.

I did decide not to shoot tonight, as it just feels his BG was too low for 3u. It seems I should be decreasing his units by 0.25 at the next shot if he gets below 90 with the current units he's at. Seems like I definitely should've decreased sooner. I don't want to put pressure on anyone, so I ask this as a generalized question so that way there's less pressure. Would it seem to be more advised I give him 2.75u at his next dosage? That is, if his BG is high enough to get a shot. I suppose it'd help if I mention I do have syringes with half markings, but they don't show .25 markings.

Again, I don't wish to be putting pressure on you, or anyone, from asking dosing questions, or a lot of questions. Thank you for all the help you've been giving me, previously and now!!

 

[Suzanne & Darcy]

Let me look again at the spreadsheet and make a recommendation. No pressure. I do this all the time for ProZinc members (help with dosing as well as many other things.) Asking questions is always a good thing!! This is important!

 

[Suzanne & Darcy]

Are you using the ReliOn for all the BG tests now? It looks like that from your notes.

I would actually like to see you reduce the dose to 2.5 starting tomorrow. He will probably be high in the morning due to the skipped shot tonight, but I would shoot 2.5 units regardless. Jojo needs some time on a stable dose if possible. A lot of dose changes from day to day can really make the numbers unstable. This doesn’t mean that you can’t do a slightly reduced dose if the preshot number is low. We can gradually work up to shooting lower preshots. I would like to not have skipped shots though. There’s rarely any reason to actually skip a shot if you will be around to monitor the cycle a bit.

 

[Shwayna]

Are you using the ReliOn for all the BG tests now? It looks like that from your notes.

I would actually like to see you reduce the dose to 2.5 starting tomorrow. He will probably be high in the morning due to the skipped shot tonight, but I would shoot 2.5 units regardless. Jojo needs some time on a stable dose if possible. A lot of dose changes from day to day can really make the numbers unstable. This doesn’t mean that you can’t do a slightly reduced dose if the preshot number is low. We can gradually work up to shooting lower preshots. I would like to not have skipped shots though. There’s rarely any reason to actually skip a shot if you will be around to monitor the cycle a bit.

Yes, I am using the Relion permanently from now on!

I will start him on 2.5u and keep that for a week, unless something seems to change. I will try not to skip shots, I just did so tonight as I was unsure.

I really appreciate your help. I know I have said this many times, but I do mean it!

 

[Suzanne & Darcy]

What is Jojo eating? I see Friskies shreds? Those are not low carb to the best of my knowledge. I looked up several of the flavors and see 15-18 percent carbs on a dry matter basis. The dry matter basis is the value that you need to look at.

 

[Suzanne & Darcy]

What is your time zone and what is your shot time?

I understand about the skipped shot tonight. I would just like to try to be around to help make those decisions if/when it happens again. We can talk about options in advance sometimes too.

You are doing just fine! It’s going to be okay!

 

[Shwayna]

What is your time zone and what is your shot time?

I understand about the skipped shot tonight. I would just like to try to be around to help make those decisions if/when it happens again. We can talk about options in advance sometimes too.

You are doing just fine! It’s going to be okay!

I'm in central daylight time, so it's currently 11:20 PM for me currently.

To respond to your previous question, he is fed primarily Friskies Shreds with some Pate mixed in. Jojo won't touch Pate at all unless it's mixed in. I thought you looked at the carbs from the as fed percentage, as no shock, that's what my vet told me .

 

[Suzanne & Darcy]

So what time will your shot be tomorrow morning?

 

[Suzanne & Darcy]

It’s almost one a.m. here now, but I will check for your message tomorrow morning!

 

[Shwayna]

So what time will your shot be tomorrow morning?

Sorry, totally forgot to say! He gets shots at 6:30 AM and PM. Feedings are at 8:30 AM/PM and 10:30 AM/PM.

 

[Suzanne & Darcy]

Well if this morning’s AMPS was 274 that’s not too bad! Ofd that it’s exactly the same number as yesterday. Did you give the 2.5 units?

 

[Shwayna]

Well if this morning’s AMPS was 274 that’s not too bad! Ofd that it’s exactly the same number as yesterday. Did you give the 2.5 units?

Good morning, yes I did give the 2.5u! Totally forgot to mark it down. I also thought it was weird that it was the exact same as yesterday. Third time a pre-shot has read 274 lol!

 

[Suzanne & Darcy]

I hope you can find some food that he likes that’s low carb. The food is probably the reason why his dose is on the higher end. If you do, you will have to be very careful about transitioning slowly so that his BG won’t drop too low.

 

[Shwayna]

I hope you can find some food that he likes that’s low carb. The food is probably the reason why his dose is on the higher end. If you do, you will have to be very careful about transitioning slowly so that his BG won’t drop too low.

For his meals, he already gets some Pate mixed in with the Shreds. I may see if I can start trying to gradually give him more Pate than Shreds so I can see if he'll accept Pate. I could also try finding a meal topper to add to see if that'll make him enjoy it more, just need to make sure it's a low carb meal topper. Having a diabetic cat has made me realize how many "healthy" treat options actually have a ton of carbs in them.

 

[Connie & Parker & Moonie]

For his meals, he already gets some Pate mixed in with the Shreds. I may see if I can start trying to gradually give him more Pate than Shreds so I can see if he'll accept Pate. I could also try finding a meal topper to add to see if that'll make him enjoy it more, just need to make sure it's a low carb meal topper. Having a diabetic cat has made me realize how many "healthy" treat options actually have a ton of carbs in them.

Freeze dried protein of all kinds are a great meal topper. I don't know what kind of textures Jojo prefers, but Moonie is a gravy fiend and refused all pates. Weruva's OMG gravy line is a higher carb LC option that Moonie loves (4-7 percent carbs). Weruva publishes the % carbs on their website so if you go this route, I'd check the particular option before you buy. If he likes shredded textures, the FF Gourmet Naturals Chicken also qualifies as LC.

 

[Shwayna]

Freeze dried protein of all kinds are a great meal topper. I don't know what kind of textures Jojo prefers, but Moonie is a gravy fiend and refused all pates. Weruva's OMG gravy line is a higher carb LC option that Moonie loves (4-7 percent carbs). Weruva publishes the % carbs on their website so if you go this route, I'd check the particular option before you buy. If he likes shredded textures, the FF Gourmet Naturals Chicken also qualifies as LC.

Jojo seems to enjoy freeze dried chicken, if he's able to actually see or smell it lol. I also heard some cats enjoy Bonito flakes, aka dried tuna flakes, and the serving sizes are usually about 1/2 cup (which he definitely won't get that much). The joys of having a picky cat!

 

[Suzanne & Darcy]

A good nadir today of 94. Jojo really drops fast. You may need to move the first feeding/snack up to +1 or +1.5 to slow him down a bit. A steep drop can trigger a bounce would like to see that nadir happen a little later in the cycle, but it isn’t uncommon for newly diagnosed cats to nadir around +4.

No more food now as we don’t want him going up further.

 

[Suzanne & Darcy]

Jojo seems to enjoy freeze dried chicken, if he's able to actually see or smell it lol. I also heard some cats enjoy Bonito flakes, aka dried tuna flakes, and the serving sizes are usually about 1/2 cup (which he definitely won't get that much). The joys of having a picky cat!

My cats do love Bonita flakes, however, I would never use it for more than just sprinkling on top as an appetizer/appetite stimulant. It’s not nutritionally complete so it’s not a meal substitute, but they do love it and it’s a high protein low-carb snack.

 

[Suzanne & Darcy]

Here’s a list of some foods that are low in carbs and are low phosphorus. Low phosphorus is better for the kidneys, although I am not saying you need that now if Jojo’s kidneys are sound. I feed all my cats lower phosphorus foods as a preventative. I was going to suggest the Weruva OMG line as it has more texture than the pates. Some of the Tiki Cat foods have more texture. I have also noticed that a lot of the foods that call themselves grilled seem to have more chunky texture to them. Anything less than 10% carbs would be fine.

https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf

 

[Shwayna]

A good nadir today of 94. Jojo really drops fast. You may need to move the first feeding/snack up to +1 or +1.5 to slow him down a bit. A steep drop can trigger a bounce would like to see that nadir happen a little later in the cycle, but it isn’t uncommon for newly diagnosed cats to nadir around +4.

No more food now as we don’t want him going up further.

I'll likely move his first feeding to +1.5 and see if that helps, as he surprisingly doesn't like eating much, and +1 may be too soon after breakfast and dinner for him to want to eat again. He stops getting food after the +2 feeding, nor does he get treats after that point. I'll also check out the food list you sent.

I'm slightly hopeful adding some bonito flakes may help him enjoy pate more, but we'll see on that. I know cats don't seem to chew their food much, but Jojo definitely does. I'm suspecting shreds may be easier on his teeth right now, so I can always try slowly transitioning to more pate after he gets his teeth done.

I'll be testing his BG again after I send this message, as I'm trying to check every 2-3 hours for 3 days as Corky had suggested.

 

[Suzanne & Darcy]

He stops getting food after the +2 feeding, nor does he get treats after that point

I thought you said above he had snacks at 8:30 and 10:30 AM, which would be +2 and +4, which is recommended generally, I am just suggesting moving the first snack forward a little bit because he’s dropping too fast and he needs a little food to buffer that it looks like — if today is typical

 

[Suzanne & Darcy]

Sorry, totally forgot to say! He gets shots at 6:30 AM and PM. Feedings are at 8:30 AM/PM and 10:30 AM/PM.

It is OK to keep the 10:30 AM snack where it is or you could move it to 10 if you’re moving the other one up by 30 minutes. As for treats, it is important to give low carb treats with each BG test. You need to reward him each time you test.

 

[Shwayna]

I thought you said above he had snacks at 8:30 and 10:30 AM, which would be +2 and +4, which is recommended generally, I am just suggesting moving the first snack forward a little bit because he’s dropping too fast and he needs a little food to buffer that it looks like — if today is typical

Yes I totally said the wrong time, I meant to say +4! He stops being fed after +4, but gets freeze dried chicken treats for BG testing. Other than treats at testing, he doesn't get treats throughout the day.

I'll move the +2 snack to +1.5 or +1. I will test tomorrow an hour after PM shot to see how he's doing and decide if +1 or +1.5 may work better for him.

Edit: Said AM instead of PM for testing. I will test him at +1 for AM too, but meant to say PM as I'm talking about tonight!

 

[Suzanne & Darcy]

Yes I totally said the wrong time, I meant to say +4! He stops being fed after +4, but gets freeze dried chicken treats for BG testing. Other than treats at testing, he doesn't get treats throughout the day.

I'll move the +2 snack to +1.5 or +1. I will test tomorrow an hour after PM shot to see how he's doing and decide if +1 or +1.5 may work better for him.

Edit: Said AM instead of PM for testing. I will test him at +1 for AM too, but meant to say PM as I'm talking about tonight!

Perfect!

 

[Shwayna]

Perfect!

Hi, sorry to bother.

I just checked Jojo's BG for +4, and it's down to 75. While I'm not very concerned, I am wondering if you think I should lower his insulin amount for his next shot? It would be the AM shot. I do know the Prozinc dosing guide says to go down by 0.25u if the cat gets under 90, but it seems he does go down pretty fast after he gets insulin. I'm wondering if it may be more wise to go down by another .50, or if going down by 0.25 would be better. Thanks!

 

[Suzanne & Darcy]

Oh shoot! I looked at this message very early this morning and was going to reply and then something happened, which took me away from it.

What an absolutely fantastic cycle last night with all of those greens. So beautiful! For now, if you would like to continue following the SLGS dosing protocol, reduce the dose by .25 units. More on this later, I’ll send this message now.

 

[Suzanne & Darcy]

Oh no. I just looked at your spreadsheet. Don’t skip the shot today if you can possibly help it.

 

[Suzanne & Darcy]

This is exactly what we want to happen. He’s having a really good pre-shot this morning. How long ago was it that you last tested? Can you retest again quickly and see where the BG is?

 

[Suzanne & Darcy]

Also, we need to talk about these glucometers and a thing called allowable “meter variance.” First of all, there is no difference between a 151 and a 156 on the glucometer — that is very stable blood sugar. In fact, these glucometers are permitted to have up to a 20% variance, which means that you could test the same drop of blood one time and get a number of say 100 and then test that same drop of blood again and get a number of 120 — and that would all be within the meter variance and it would be considered very stable flat blood glucose for the most part. I know this gets a little tricky in the lower numbers because we are more concerned when the numbers are lower. I know it’s confusing.

Anyway, it is now probably two hours past Jojo’s shot time — and you didn’t shoot —so at this point I wouldn’t advise shooting because it’s going to mess your schedule up too badly. I wish I had seen this message earlier, because I do think that it would’ve been better to give a dose of insulin. You are getting some really fantastic progress with JoJo.

Don’t worry though. Everything will be okay!

 

[Suzanne & Darcy]

I would like to talk about the different dosing protocols and what would be in the best interest of getting Jojo regulated. We can talk about that later, but even with the SLGS protocol, you can shoot anything 90 and above; however, these lower pre-shots are new to you…. so I wouldn’t want you to do that on your own anyway, without some help and advice and support!

 

[Suzanne & Darcy]

Talk to you later. Okay?

 

[Shwayna]

Oh shoot! I looked at this message very early this morning and was going to reply and then something happened, which took me away from it.

What an absolutely fantastic cycle last night with all of those greens. So beautiful! For now, if you would like to continue following the SLGS dosing protocol, reduce the dose by .25 units. More on this later, I’ll send this message now.

I will reduce his next shot by .25 to follow the protocol! I did unfortunately get quite busy this morning, so I didn't shoot, so I apologize. I'll make sure not to skip out on the shots again. I was unsure if that was considered a safe spot or not since he seems to drop quite quickly after getting insulin.

And don't apologize for not having responded earlier. Life gets busy! I just tend to be a nervous freak and overthink, but you really helped out!

Thank you!

 

[Suzanne & Darcy]

Well, since we don’t yet have a lot of data on shooting lower pre-shots with Jojo, I may have recommended that you only give 2 units this morning and then gather some data to see how the cycle went. I see that you have shot a 169 before with 2 units and so I feel pretty confident that 2 units would not have been too much insulin for this morning. In fact, probably 2.25 units would also be fine. Either way, as long as you are at home with Jojo to monitor the cycle and to intervene with food if necessary, I would not worry about Jojo being in any danger.

 

[Shwayna]

Well, since we don’t yet have a lot of data on shooting lower pre-shots with Jojo, I may have recommended that you only give 2 units this morning and then gather some data to see how the cycle went. I see that you have shot a 169 before with 2 units and so I feel pretty confident that 2 units would not have been too much insulin for this morning. In fact, probably 2.25 units would also be fine. Either way, as long as you are at home with Jojo to monitor the cycle and to intervene with food if necessary, I would not worry about Jojo being in any danger.

I will be home for the next few days. This morning just got busy, so I suppose not shooting worked out a little.

I may try 2.25u for tonight and see how he does with that. I know his BG will likely be higher than it's been lately since he didn't get his AM shot. Again, thank you for all your help!

 

[Suzanne & Darcy]

That is correct. If following SLGS right now, then the new dose going forward is 2.25 units.

 

[Suzanne & Darcy]

I don’t understand the BG readings in the +1 cell for last night or tonight. 240/177? 249/131?

 

[Shwayna]

I don’t understand the BG readings in the +1 cell for last night or tonight.

Jojo got his PM shot at 6:30 PM for my time, and I re-tested at 7:30 PM and then 8:00 PM. I'm not too sure how to space out the readings if they're in the same cell, so I put a slash. I do realize I forgot to put +1 after the first readings for both nights, so I've adjusted that. Last night, the 240 was at +1, while the 177 was at +1.50. Tonight, the 249 was at +1, while the 131 was at +1.50.

Sorry if that makes no sense.

 

[Suzanne & Darcy]

Here are the instructions about how to do advanced recording of numbers on your spreadsheet. We need all the numbers in there. Scroll down to the part about basic recording and then advanced recording.

https://felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/

 

[Suzanne & Darcy]

It’s okay. I just wanted to make sure about the numbers. Usually it’s ###@+1.5, etc. There are a couple of ways of doing it that are standard. The “How to Use the Spreadsheet” thing with advanced recording (above) will help.

 

[Shwayna]

It’s okay. I just wanted to make sure about the numbers. Usually it’s ###@+1.5, etc. There are a couple of ways of doing it that are standard. The “How to Use the Spreadsheet” thing with advanced recording (above) will help.

Today I have learned how to stack stuff in google sheets! Does something like this make more sense for people viewing the numbers?

 

[Suzanne & Darcy]

Anyway, Jojo is dropping much too fast. He needs more carbs at his main meals, breakfast and dinner.

That’s sounds weird, I know, but some cats actually do better and give you better numbers overall with a few more carbs, while still staying below 10 percent carbs. In his case he just looks like a cat who needs a few more carbs.

 

[Shwayna]

Anyway, Jojo is dropping much too fast. He needs more carbs at his main meals, breakfast and dinner.

That’s sounds weird, I know, but some cats actually do better and give you better numbers overall with a few more carbs, while still staying below 10 percent carbs. In his case he just looks like a cat who needs a few more carbs.

I'll try to figure out a way to add some more carbs to his main meals. He's already at a spot where he won't eat more food, and he's always been a cat that doesn't like eating a lot at once. I have to split his main meals into his snacks because he leaves about half the food in the bowl.

It does feel weird that he seems to drop so fast. Part of me wonders if I could have a defective Relion, but I suppose there is the chance he just drops fast?

 

[Shwayna]

Anyway, Jojo is dropping much too fast. He needs more carbs at his main meals, breakfast and dinner.

That’s sounds weird, I know, but some cats actually do better and give you better numbers overall with a few more carbs, while still staying below 10 percent carbs. In his case he just looks like a cat who needs a few more carbs.

Jojo is down to 70 already... I'm thinking I'm going to give him his second snack now since it's only an hour earlier than usual, then check his BG again.

 

[Suzanne & Darcy]

I think that is a good idea. He is a diver. I think he will level off though. I would have retested after that 70 though— in 30 minutes. Have you rechecked the BG after the snack?

 

[Shwayna]

I think that is a good idea. He is a diver. I think he will level off though. I would have retested after that 70 though— in 30 minutes. Have you rechecked the BG after the snack?

I just checked and he's at 71. I'll test again in 30 minutes to see if he levels off or not.

 

[Suzanne & Darcy]

Something wacky has happened to your spreadsheet. Or is it just what I am seeing?

New dose for tomorrow will be 2 units.

 

[Suzanne & Darcy]

I just checked and he's at 71. I'll test again in 30 minutes to see if he levels off or not.

That is fantastic. A 70 and a 71. No worries. How perfect!