? Me again…with more dosing advice needed.

Stephanie & Johnny

Stephanie & Johnny

Member
Hi there! Thank you all for being so helpful and patient with me.

This evening’s question is as follows:

Today’s curve was a slow and steady decline to a nadir of 80 at around +8. I gave approximately .75 units this morning.

Since reaching the “green” on the Libre at +6, we’ve been steady in the good area.

I made no diet changes today, and Johnny’s been steady grazing his food throughout the day as normal. No additional exercise either.

Johnny’s next dose is in 90 minutes. Should I pick up all of his food until then to see what his PMPS is?

My most recent test/scan was at +10 and was 102 on the Libre and 116 on the Alphatrak.

I’m sure I will be posting again at shot time with more questions, but in the meantime…should I “mean Mommy” starve him?

Spreadsheet is updated and attached is the screenshot of today’s Libre curve.

https://drive.google.com/file/d/1zWp9sqvmFVciwKhFnC76oDv1RKx3h6uJ/view?usp=drivesdk


Thanks!

Also - we go in tomorrow for his 2 week check…I’m very curious to hear what the vet thinks of this!
 
Yes food should always be withheld 2 hours before preshot for consistency.

What specifically were the diet changes?

He technically earned another reduction for a new dose of 0.5U, but if he were my cat I'd be inclined to hold this dose another cycle or two to see how he does - provided you can monitor. BUT if you removed dry and/or decreased carb content enough, we'll want to rethink the dose.
 
Hi there! I meant there have been no diet changes in the past couple of days.

I’m 30 minutes until PM shot, and he’s now at 122 on the Libre. I’m definitely not comfortable enough shooting this low, even at a reduced dose.

At what point do I call it and just skip the dose…and when can I feed this poor starving monster? (Hehe, he’s not really a poor starving monster, but don’t tell him that.)
 
You can skip and call it an experiment if you'd like. Since he's only 122, that's nearly flat the whole last half of the cycle, so I definitely wouldn't do full dose. You could try a drop dose - push plunger as far down as you can, hold it, insert into vial, then let it go. Result is one drop in the syringe, not really visible. When giving the shot, you'd insert into scruff or wherever, and hold plunger down for 10 seconds to give it time to absorb.

Honestly, I'm inclined to just say skip and see what happens.

You can feed him whenever you give the shot or decide not to shoot.
 
I suspect he still needs a small amount of insulin but a skip would be a good piece of data
 
As we say, you hold the syringe. You can continue stalling without food up to an hour if you'd like to get a number you feel comfortable shooting, then be off schedule tomorrow. Or you can skip, drop dose, or token dose of like 0.1-ish units (so plunger just barely drawn up). All based on your comfort level, schedule, and ability to monitor
 
Thank you! He’s at 129 and it’s shot time. I fed him and am going to skip his dose and monitor through the night. Actually, I’ll do the plunger single drop just to ease my mind.
 
So did you do the drop or skip? One post you said drop, but latest post and SS look like skip? He's not doing too bad, we'll see where he ends up by AMPS.

I'm not usually around in the mornings, but if he's 200 or above I'd try 0.5U or 0.75U again (reminder per dosing guidelines his new dose would be 0.5U given the drop below 90). 150-200 you have a few options - drop dose, but realistically looking at tonight's numbers I think 0.1-0.25U would be ok. 125-150 - Id try a drop. All these suggestions assume you can be around to monitor; if you can't, err on the conservative/cautious/safe side
 
So I *thought* I did the drop, but realized I definitely did not do it right…so I’m fairly certain he got no dose.

Right now at what would have been +4, his Libre is scanning at 161.

I’ll be with him all day tomorrow for monitoring and we have a vet visit in the morning.
 
Ok sounds good. Know the vet visit will likely send his numbers up from stress - I would not change how you dose based on that, just saying it may be an outlier day of data.
 
Welllll not to be a Debbie Downer but we like to see a lot more green (my case is a little different due to acromegaly but see my spreadsheet for OTJ trial back in July), as the greens are where the pancreas is healing and also more normal numbers for cats. Something is definitely happening though. Vets tend to jump the gun on calling remission, so just be a little wary of that...calling it too soon usually results in a relapse
 
Update: Gave .5 units this morning with a AMPS of 174. I figured it would offset any increase in BG resulting of stress at the vet visit. Boy was I wrong! He dropped to 80 at +2 and then 49 at +3. I fed him a couple of the devil’s treats (Temptations) to slow the drop. He seems to be holding steady hovering around 50 now at +3.5.

In other news, vet visit went well. Agreed to dose reduction of .5 units twice a day, and not shooting below 150.

Honestly though, seeing how this morning went, I’m thinking even .5 units may be too much. I’m sending over a week of graphs next week and we’ll go from there.
 
Wow that's a little unexpected. Yes you'd be down to 0.25U now, but even that may be too much. I'd try drop dose a few more times to see what happens.

If that sends him too low, and skips continue to send him into higher blues/yellows then may need to get opinions on lantus
 
Ok good. When you get that big of a difference always good to get a 3rd number just to make sure. I know a lot of people who struggle with the Libres (all of them) reading much lower than any other meter
 
Good to know. I’m also curious why a number would show as too low on the Libre/human meter spreadsheet, but ok on the pet meter one…with both tests being taken at the same time.
 
Well now I’m wondering if the Libre is just showing too low of numbers???

Just tested at +5 and got 88 on Libre (dark green) and 152 on AT (blue).

I think I need to rely more on the AT, rather than the Libre…which brings up new questions:

1) What is the no shoot number on the AT?
2) What is the “take action” number on the AT?
 
There is a difference between interstitial fluid and capillary blood readings, often when theres rapid changes (after eating, dosing, etc). But yes many people have borderline lost their minds over it because which do you trust? That low number always in the back of your head. The Libre sensor is known for reading low which is why we say double check it with a meter.
 
Stephanie & Johnny said:
Well now I’m wondering if the Libre is just showing too low of numbers???

Just tested at +5 and got 88 on Libre (dark green) and 152 on AT (blue).

I think I need to rely more on the AT, rather than the Libre…which brings up new questions:

1) What is the no shoot number on the AT?
2) What is the “take action” number on the AT?
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Libre might be going bad already ha

No shoot and reduction thresholds are still the same. Take action however is 68, it's considered the "equivalent" of 50 on a human meter
 
So he may not actually have been going low before?

Sorry for the billion questions. Every time I think I figure something out, a twist gets tossed in.
 
Stephanie & Johnny said:
So he may not actually have been going low before?

Sorry for the billion questions. Every time I think I figure something out, a twist gets tossed in.
Click to expand...
It's honestly hard to say and I'm not comfortable saying yes or no. The AT seemed to corroborate a lot of the numbers, or at least close to it. I'd say if you get anything below 75-ish may be worth checking with AT.
 
Ok. I’m losing my mind here.

After yesterday’s afternoon lows, Johnny went up to the upper 100s (Libre) for the remainder of the day. His PMPS was 180 on the Libre and 233 on the AT. I proceeded with .5 units.

He stayed in the 100s overnight on the Libre and never went LO.

This morning, his AMPS was 173 on the Libre and 223 on the AT. I proceeded with his .5 unit shot. And just like yesterday, he dropped to LO on the Libre and 48 on the AT at +3.

Does this make any sense why he’d go low during the day, but not at night on the same dose? Could he not be eating enough in the morning? I don’t notice a different in his eating between the two times, but I guess it could be possible.
He also gets 100 units of sub-a fluids in the evenings, which I give 3 hours before his shot. Could that be doing something?

His spreadsheet is updated and attached is his recent Libre log.
https://drive.google.com/file/d/1JBKAnp4QHTIj4tvJbAisi6UlxzduXGJe/view?usp=drivesdk
 
Definitely possible. You could try different doses...we usually don't recommend it but may be worth a try (as always assuming you can monitor and intervene if needed).

New dose is technically 0.25U with that drop...

If it were my cat, I would try to move or split the fluids and try to keep consistent insulin dose if possible. Have you noticed how long the pocket of fluid takes to absorb? Are you giving fluids in same location as shot? Can you give 50mL twice a day instead? Not sure how well he sits for the fluids.

If none of that is possible, again if my cat, I'd keep fluids where they are and try 0.5U at night and drop dose or 0.1U during the day for a few days to see how it goes (assuming van monitor, intervene, and take reductions as necessary).
 
Hi there! Thank you for continuing to put up with me. :)

I guess it *technically* takes 24 hours for the fluids to fully absorb. By the three hour mark when I shoot, I'm fairly certain the water bubble has traveled down his leg, but it is very likely that there is still enough remaining in his scruff to cause dilution.

I can split the fluids up, he is really good for me when I am poking him all the time. However, since I like to three hours between fluids and the shot, it really isn't feasible to go the split route...I know it sounds awful and selfish, but I just know me and a 5am wakeup for fluids wouldn't be safe for either of us when needles are involved.

I think this evening I will do his normal fluids at 5PM, and then his PM shot at the normal time (8PM) towards the back of his body as far away from the fluid pouch as possible...and reduce the dose to closer to .25. Full disclosure - I haven't received my 1/2 unit needles, so these under 1 unit doses are eyeballed until they arrive Saturday.

I can't believe it took me this long to put two and two together with his fluids. I swear, sometimes, I can't believe I am able to function in life.

Regarding the drop earlier today, I did multiple tests with the Libre and the AT...and I treated based on the AT numbers...letting him stay "LO" on the Libre for a longer amount of time (obviously, I was all up on him monitoring for any hypo symptoms and had my kit ready to go just in case). I also made sure to not do my "panic intervention" with tons of Temptations and stew to bring him up quicker. I went with one Temptation and a half packet of Delectables Stew. That seemed to bring him up slower and has let him stay in the "green" area on the Libre for much longer, rather than spiking quickly. I think that may have been messing up the PM dosing as well, since he may have had a falsely inflated BG due to the rebound from the low. I hope that makes sense...trying to wrap my head around all of this.

Spreadsheet is updated if you want to see some lovely green numbers this afternoon. Down with the blues!!!
 
No judgment on the splitting and not considering fluids lol fluids never really seemed to affect my cat BUT I gave fluid in flank and shots in scruff. Who knows if that makes a difference.

Beautiful stretch of greens!

You'll get it figured out...it's a bit of trial and error til you settle into a groove, especially when there's other concurrent things to manage. It is possible the higher PM are very small and quickly cleared bounces but I'm not 100% convinced.
 
SubQ fluids can cause BG to drop lower, not usually higher. Some of us used to time the fluid administration to when the BG was in higher ranges. Also, I wouldn’t split the fluid administration into two sessions. Dr. Lisa (author of current food charts who used to post here frequently) once said she didn’t consider it worthwhile to poke a cat for less than 100mls (paraphrasing).

Tresaderm has a steroid component and has been known to raise BG in some cats. Higher carb foods can also raise BG. Stopping the tresaderm plus food change to a lower-carb option can definitely lower insulin needs, so what you’re seeing with the need for less insulin makes perfect sense.

Good job staying on top of the numbers.

edited to add: I wonder if the trend for higher BG overnight was related to the temptations you fed during the day to bring up the BG.
 
JL and Chip said:
SubQ fluids can cause BG to drop lower, not usually higher. Some of us used to time the fluid administration to when the BG was in higher ranges. Also, I wouldn’t split the fluid administration into two sessions. Dr. Lisa (author of current food charts who used to post here frequently) once said she didn’t consider it worthwhile to poke a cat for less than 100mls (paraphrasing).

Tresaderm has a steroid component and has been known to raise BG in some cats. Higher carb foods can also raise BG. Stopping the tresaderm plus food change to a lower-carb option can definitely lower insulin needs, so what you’re seeing with the need for less insulin makes perfect sense.

Good job staying on top of the numbers.
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Thank you! He's my baby...tomorrow is actually his adoption date anniversary, from 2005! He was a wee kitten then. He has all of my heart and I would do anything for him. <3

That makes sense about using the fluids to reduce the BG number. Figuring out his PM dosing and considering the fluids is definitely my current puzzle piece.
 
JL and Chip said:
edited to add: I wonder if the trend for higher BG overnight was related to the temptations you fed during the day to bring up the BG.
Click to expand...

I could see that...I definitely think my hypo freak outs were scewing numbers. Can't wait to see what tonight brings since I only gave ONE of the devil's treats...and not a bunch.
 
With a 3 hour separation, I don’t think the fluids are diluting the impact of the insulin shot. Like I added earlier, it might just have been holdover from the temptation treats.

What dose are you thinking? That 48 definitely warrants a dose reduction.
 
JL and Chip said:
With a 3 hour separation, I don’t think the fluids are diluting the impact of the insulin shot. Like I added earlier, it might just have been holdover from the temptation treats.

What dose are you thinking? That 48 definitely warrants a dose reduction.
Click to expand...

I'm thinking a very eyeballed .25 since I still only have 1 unit hashmark needles until Saturday.
 
These meters don't want to make it easy for you...just anecdotally, especially after seeing tonight's data, I'd go with AT over Libre overall.

The Libre is a nice potential warning system and to keep an eye while you can't be testing, but I'd use AT to double check anything that would warrant reduction or food intervention. Numbers tonight look good, curious to see if the shot location change helps as well as only 1 treat.

Which brings up something you'll need to think about - technically you're following SLGS because of the Temptations, with reductions below 90. I think even the drop dose is going to take you below that. He still runs a little higher than desired, so still probably needs a little bit of insulin The Modified Method you wouldn't reduce until below 50, but it would require no dry (instead you could mix some karo in with MC to make HC). That may get you into the BG range that really gets his pancreas back up and running, but some people find that a little more stressful.

No sense overanalyzing what to do right now until we see how he does, just something to mull over since I suspect you'll soon be down to a drop dose.
 
Hi!

So this evening, his PMPS was 138 on the Libre and 179 on the AT. I went with a very approximate 0.25 unit dose. Really hard to tell with these syringes, but it was definitely less than the approximate .5 unit from this morning.

His BG at +3 was 54 on the Libre and 104 on the AT. I’ll continue checking through the night, but I’m hopeful that we’ve hit the sweet spot at .25 to get him more time in the green for healing. I definitely don’t want to risk a too early remission, so I’d be happy keeping him on a teeny dose for some time in order to support a strong comeback for his pancreas.

What is MC and HC?

If I went that route, would it just be eliminating the Temptation cookie, or ALL dry food? I really like the Young Again that he has been eating (in addition to the Weruva & Tiki) because it is higher in calories and this slonker needs to put on some weight.
 
FrostD said:
These meters don't want to make it easy for you...just anecdotally, especially after seeing tonight's data, I'd go with AT over Libre overall.

The Libre is a nice potential warning system and to keep an eye while you can't be testing, but I'd use AT to double check anything that would warrant reduction or food intervention. Numbers tonight look good, curious to see if the shot location change helps as well as only 1 treat.

Which brings up something you'll need to think about - technically you're following SLGS because of the Temptations, with reductions below 90. I think even the drop dose is going to take you below that. He still runs a little higher than desired, so still probably needs a little bit of insulin The Modified Method you wouldn't reduce until below 50, but it would require no dry (instead you could mix some karo in with MC to make HC). That may get you into the BG range that really gets his pancreas back up and running, but some people find that a little more stressful.

No sense overanalyzing what to do right now until we see how he does, just something to mull over since I suspect you'll soon be down to a drop dose.
Click to expand...

Oh, also, I shot 3 hours post sub-a fluids and injected on his back right haunch/under the ribs/hip area.

I’ll definitely use the AT as my guide for his numbers, but I’m absolutely hooked on the Libre for my easy sanity checks.
 
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