My Tasha's in low-dose territory

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stacia

stacia

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Hi everyone. I posted in the main health forum and Sue suggested I come here for more specific advice. Here's a link to that post: http://www.felinediabetes.com/FDMB/threads/tiny-dosing-sub-200-amps-pmps-assistance-needed.143635/

Basically, Tasha's been dropping her pre-shots under 200 quite consistently. Usually we delay a bit, make sure she's rising, and give a small shot. Last night, in an hour's time, she had come up only 18 to 149 (realizing meters aren't 100% accurate) so I gave only 0.1u, tested +8 at 161, then this morning, she was 151 at AMPS. I gave her just 1 drop and got a +6 of 142.

I'm wondering what to do tonight depending on what kind of number I get - we can't get her to settle in anywhere. I'm afraid of overdosing, afraid of under dosing. She acts great.

A little info - I'm generally available during the day to grab mid-cycle tests (it was suggested that might be helpful so I took one today) and to keep an eye on her. She gets mid-cycle meals from a feeder. I'm open to whatever suggestions. If she's moving to that magic good place I refuse to jinx, I don't want to screw it up. Please assist?
 
Hi, Stacia! Welcome to the land of mini-dosing. My Bat-Bat has been there for quite a while now, a dinky dose as needed (see her SS, but please note that because we are using an AlphaTrak2 meter, our BG reference range is higher than for human meters like yours).

One of the first things I've noticed: Your SS is almost devoid of mid-cycle numbers; there's barely a handful of them in there. While it's really great that you've always tested at AMPS/PMPS, those #s are akin to the edges of a puzzle - without more of the middle pieces put together, you've only got a partial view of what the total picture is like for Tasha.

Even though she's down to a mini-dose right now, I'd recommend doing a full curve when it's convenient to you (maybe over a weekend?) to see what she's been doing during the rest of her cycle; this may help you determine what your next move should be. And do try to get a couple of mid-cycle #s whenever you can, too, from here on out.

Just a few questions I can think of, off the top of my head:
- How much does Tasha weigh, and would you say this is her optimum weight? (Is best for a diabetic kitty to be slender, with a little cut-in at the "waistline".) If you haven't already seen the body condition chart, here it is: body condition chart
- How much food does Tasha get every 24 hrs (in ounces) and which formulas of Friskies pates are you serving? (Some cats are extremely carb-sensitive; going to a formula that is a just carb or two less can actually make a real impact in those kitties' BG #s. Found that out about my own cat...)
- Has Tasha ever had a dental cleaning? Because if she hasn't, you might seriously want to consider having the vet do that. Even a slight case of gingivitis (gum inflammation) can factor into her BG numbers. (Bat-Bat is having her first-ever dental on 9/15; I'm hoping this will help stop her from teetering on the edge of remission!)
 
I was doing semi-regular curves but when we switched vets in January, they said not-so-much, in favor of fructosamine checks. I'm going to skip a long story and say that while we're happy with this vet overall, they seem to think we're made of money. At this point, I'm going to start grabbing more mid-cycles. I should be able to do a curve tomorrow since I work from home and only have to run out briefly.

She's eating approximately one can of Friskies every 24 hrs, so 5.5 oz? She receives 1/2 can Poultry Platter in the AM, 1/2 can Supreme Supper at night. Those 1/2 cans are then divided up to put just over half of that in her dish post-shot, the rest divided up in her automatic feeder so she gets mini meals. Ideally, the vet said she should be getting about 1 1/3 can per day but I can't get her to eat more than what she's currently taking in. She was around 10.5 lbs in mid-June and the vet was happy with that, said she could gain a bit (hence the 1 1/3 can). The only problem with the body condition chart is, well, meet Tasha:

IMG_20150816_210242.JPG
She has a bit of hair obstructing her view... (Also, that's where she's currently decided to live. She won't be denied her CostCo box - it's a perfect fit, faceplant and all.) She feels indented properly though, not ribby, not fatty.

Tasha's had 3 dentals total I believe. Her last one was very late in 2013. At last check, they said she had very low-level need for one at this point.

I need to get her back in for a kidney recheck, etc. She was put at Stage 2 kidney disease about a year ago, but no signs of progression. But, like I said, we had a bit of a "made of money, charge all the things" run-in with the vet so we've been laying low, especially with things going well.
 
I agree with Robin that it would be helpful to get some mid-cycle tests. Tasha could very well be running flat so if that is the case, maybe a drop more would help her get lower. Do you know the carb levels in the two types of food that you give Tasha?
 
Here's where we are with foods -

Poultry platter is 9 carbs, Supreme Supper is 8. She was, until a few weeks ago, 50/50 at dinner time Supreme Supper one night, Chicken and Tuna the next, which was also 9. But she won't eat Liver and Chicken, won't eat Turkey and Giblets. Everything else in the Classic Pates is over 10 or seafood, which I'm trying to avoid. We were using some of the Special Diet until Friskies discontinued it.
 
Your dose looks good tonight. If you can be around, you can chase the dose, so as soon as she got to 200, then shoot. If you have the schedule to do that, it works well. Skip if too low, then shoot as soon as she reaches your target (180/200). Just be sure she is rising and that it is longer than 12 hours since the last shot
 
stacia said:
Here's where we are with foods -

Poultry platter is 9 carbs, Supreme Supper is 8. She was, until a few weeks ago, 50/50 at dinner time Supreme Supper one night, Chicken and Tuna the next, which was also 9. But she won't eat Liver and Chicken, won't eat Turkey and Giblets. Everything else in the Classic Pates is over 10 or seafood, which I'm trying to avoid. We were using some of the Special Diet until Friskies discontinued it.
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As the current foods you're using are at 8% & 9% carbs, you might want to go for something that's more like 4% carbs.
I was really shocked when I discovered how super carb-sensitive Bat-Bat's body actually is! Just the difference of a few less carbs can make a tremendous difference in BG #s.

I was taken by surprise - when I tried putting Bat-Bat on food that was just 1% (!) more carbs (feeding @ the same quantity as her other canned food) - that this tiny increase in carbs actually started raising her glucose levels! So I ended up mixing the two different formulas at each meal and barely reducing the quantity ... and that solved the problem.

Here is a list of ultra-low carb choices I had culled from Dr. Pierson's food chart; may find it helpful. (Please note that the Merrick BG formula may have been discontinued ...)
 

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You might check out some of the other spreadsheets, Staci. Luann is dealing with the same issues - dosing small amounts at lower ranges and managing low nadirs with food. This time of moving OTJ (anti jinx) is a difficult part of the sugar dance. You want to be a little aggressive, keeping her in lower ranges but at the same time, making sure she is safe. This is especially hard if you'd like a life at the same time. Usually ( but not always - see Bat Bat's spreadsheet) it is a fairly short period before they are too low consistently to shoot.
 
Thanks for the responses - sorry so long between my replies. I'm playing single cat-mama at the moment while my husband's out of town while juggling a heavy workload and some of my own medical issues. I set an alarm for 2am with the intention of testing her but it was all I could do to get out of bed and just make sure she was doing OK. Which she was, though annoyed I was waking her up. So we both went back to sleep.

I'm planning on testing every 3 hours today. She was only 160 at 7:30a, which is our ideal testing time. I waited until 8 and she was up to 183 so I gave her 0.1u. She's 157 now.

I'll check out foods (thanks, Robin) and Luann's and Bat Bat's spreadsheets this afternoon. I feel like we're in a tricky place and I don't want to mess it up so I appreciate the support. I don't want to jinx but I'm sure we all have the same goals for our babies.
 
Hey everyone - I ran a curve today and just did her evening dose. She's at 278 again. It's an exact repeat of last night's PMPS so I went with last night's dose. That makes me wonder if I need to give her 0.2u tomorrow morning instead of 0.1u. Any thoughts on that?

I took a look at the low-carb food spreadsheet and I'm going to try to source something lower for her I think. She's been finicky in the past. I hate that Friskies took away the Special Diet options she was eating well. Those who's to say we'd be here if she'd still been eating those all along?

I have to be out from about +2 to +5 but will try to at least grab a reading in the +5-7 range.
 
stacia said:
Hey everyone - I ran a curve today and just did her evening dose. She's at 278 again. It's an exact repeat of last night's PMPS so I went with last night's dose. That makes me wonder if I need to give her 0.2u tomorrow morning instead of 0.1u. Any thoughts on that?
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It looks like it would be okay, if your amps is similar. She had more room to drop today. If you decide to, can you leave out some food?
 
Sorry, I'm multitasking 80 things at once. It's almost 9pm and I'm still working. Sigh... Yes, I meant if her AMPS is similar. If it's lower, I'll either wait on it before injecting or stick with the 0.1u. Either way, she'll get food from her feeder at 11, which is roughly +3.

The elephant in the room I haven't mentioned is her "brother" Ripley. I can't leave food out because he eats everything in sight. This is why we have the automatic feeders. It's also why it's such a problem when I can't shoot her at a regular time and feed but have to wait and retest - they're used to "we test, we dine" - and when they don't, he gets aggressive with her. Unfortunately, feeding him elsewhere doesn't seem to do the trick. If there's any food out, he eats it. And usually throws it up.

I may have to add more feedings to the feeder. We only use 3 of the 5 slots right now.
 
Hello, Tasha's SS looks great. Just wanted to say hi and offer my support. The lower numbers are good to see but they are also tricky to dose especially if you are by yourself. I can relate because since Nicky's been diagnosed 2 months ago, I have been doing this dance by myself. I also have 2 other cats who are now on the same food schedule as Nicky, fixed amount twice a day. This forum has been great in coaching me on what I need to do.

I am going to have to look into an automatic feeder. Which one do you use? And do you have one for each cat?
 
I think I've jinxed everything by even posting she was in low-dose territory. 270 this morning. I gave her 0.2u. At least she hasn't peed on the floor lately. (Guaranteed flood now when I come home later - just watch!)

@Luann and Nicky - Props to you doing this on your own! My husband is a great helper - when he's here. But he travels a lot for work. And lately I haven't been well (herniated disk, some other issues). I'm fortunate that I work for myself and from home so I'm usually able to monitor her throughout the day, delay a shot, test mid cycle, etc. I don't know how some people do it!

As for feeders, we're using the PetSafe Eatwell Automatic Feeder with 5 slots. We ended up buying two because no matter what we did with amount of food or timing, our kitties wouldn't share. Now we have two side-by-side and they go off at the same time (more or less) so both cats have an opportunity to eat. It's not cooled and we don't freeze the food like some, but since it never sits more than about 8 hours based on the opening schedule, it seems to be fine.
 
Sue - I'll try that. I haven't been able to be home, unfortunately. Usually, I am. But I'm starting PT and have been chasing after some medical issues for me this week. Today, she decided to give us a pink AMPS. What in the world? We haven't had one of those since 8/8! She did get a freeze-dried chicken treat (just one) about an hour before testing due to drama with her brother and I tested her a little late, but it doesn't seem that would've been enough to cause that much of a bump.

I'm going to try chasing down some lower-carb food for her this weekend based on Robin's spreadsheet. I'm also going to get a current weight on her. Her brother is 10.6lbs so he's holding steady.
 
Dumb dumb dumb. I just gave her a .3u on 256 AMPS and she should be fine but based on yesterday, I'm not going to be able to inject anything until super late tonight. I wasn't really awake and was thinking more about numbers and trying to monitor vs thinking about how late it might be when I could inject her this evening.

She's now switched over to lower carb foods. I'm going to try to even her out tomorrow on 0.2u doses depending on her AMPS. I expect her PMPS to be super low. I have to be out for a couple of hours today but will try to grab at least a couple of mid-day numbers to see how low this puts her.
 
She might be low again tonight. But think of it as data collection. The more information, the better. The other thing you might try is to give her a nice snack around +8/9 to see if that would bump her up enough for pmps.

It's all about working with the numbers. You can use food and insulin strategically to try to manipulate the numbers where you need them to go.
 
Thanks Sue - I'll give that a try with the food around +8 or +9. I'm single kitty-momming it again the next few days and didn't sleep well, in part to my husband being up at 4am to go catch his flight. So this morning, I just wasn't thinking. A 0.2u dose would've been better. Setting alarms on my phone now so I remember to grab tests mid-cycle today. We're trying to work her back to her usual 7:30am/pm, so giving her that dose at 8:30a was a total fail if I can't bump her earlier.
 
Pfft. 237 at what would've been +10 going by this morning's dose time. Looks like I'll be fine to put her back on schedule in an hour after all. What is this cat doing?!?! Other than mocking me for ever thinking we were in low-dose territory and maybe heading for the amazing place of no-dose territory.

Nevermind, Tasha. We shall dose you forever. Sigh...
 
Don't lose sight of the fact that you are giving tiny doses. It'll be nice when you can get some nadirs and figure out how much, if any, of these are bounces. She is in good numbers at small doses.
 
You'll get there! I know it's frustrating, but as Sue said, you're giving tiny doses. That's a good place to be. :)
 
stacia said:
What is this cat doing?!?! Other than mocking me for ever thinking we were in low-dose territory and maybe heading for the amazing place of no-dose territory. Nevermind, Tasha. We shall dose you forever. Sigh...
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Try not to lose heart! I can so relate to how you're feeling (see Bat-Bat's SS). Sometimes it feels like we'll be wearing those patience pants forever, doesn't it? Hang in there; Tasha will get there!:bighug::bighug::bighug:
 
Thanks for the encouragement tonight, everyone. I'm having a hard time holding things together with my husband out of town and my own health issues. My head hurts so much I can barely see out of my left eye. I just want so badly to do the right thing by my kitty and when her reading isn't what I expect, I feel I've let her down somehow. I just need to keep perspective.
 
stacia said:
Thanks for the encouragement tonight, everyone. I'm having a hard time holding things together with my husband out of town and my own health issues. My head hurts so much I can barely see out of my left eye. I just want so badly to do the right thing by my kitty and when her reading isn't what I expect, I feel I've let her down somehow. I just need to keep perspective.
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And it's especially hard to keep a handle on that perspective when you're not feeling well ... so sorry about your head!:bighug:
 
Oh Stacia. I know. It's rough when you're going it alone for a few days and not feeling well! But you ARE doing right by your kitty! You've already done more than a lot of people would in your shoes. She is SO lucky to have you.

Keep heart! You're not alone. Even if we can't be there for you, we are still HERE for you.
 
Thanks. She was almost 300 this morning. I've switched her to lower carb food and she's eating it like a champ. She's even being a good girl and not flooding outside the box for me (she occasionally does this). Despite the numbers game, I'm so grateful she's cooperating otherwise. I'm not sure I'm at a place to properly handle it otherwise. She's happily snoozing in a ray of sunshine this morning so I can't be doing too badly.
 
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