? SS Review & help with neuropathy?

Madm4444

Madm4444

Member
@Suzanne & Darcy
@Wendy&Neko

We had decided to wait on switching to Lantus based on discussions with the IM doc a few days ago. Buster's numbers had been so much better & we wanted to change as few things as possible before the SRT (10 days away).

However, although we have had some good runs with lower numbers, it appears he is still riding in the highs a lot at night & his hind legs have suddenly gotten a lot weaker in the last 2 days.

He has been on methylcobalamin since 2/12/25. We thought we saw improvement from it early on but maybe it was the increase in his insulin dose around that time. We did not include the folic acid b/c I read here that many kitties don't need it. Should we add that now?

Thoughts on increasing dose to 15?

Thoughts on how to support him with the weakness in his hind legs? He just wants to lie down all the time now. It's breaking my heart.
 
Has he had bloodwork done recently where they checked things like potassium and phosphorus. I imagine he probably did because of the upcoming SRT.
 
So frustrating. He’s having these good daytime cycles and such bad numbers at night. Then he gets back to work again the next day.

I hesitate to recommend an increase to 15 because he has seen some lower greens on this 14.5 unit dose. However, those lower greens were Libre sensor numbers. I see that day the Libre said 53 that you tested with the AT and got a 102. So you would have to be prepared to do tests with the AT and document them on the spreadsheet. I know you can do that. So we have a dilemma. Lower greens on this dose but are they really lower greens or even green numbers at all? I would wait at least until after tomorrow to make a decision on an increase— to see if the lower numbers return.

I am so sorry that he’s having so much trouble with his legs.
 
Suzanne & Darcy said:
Has he had bloodwork done recently where they checked things like potassium and phosphorus. I imagine he probably did because of the upcoming SRT.
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Lab Test 2/19/25
Phosphorus = 4.3 (Range: 3.1 - 6.5)
Potassium = 3.95 (Range: 3.4 - 5.4)

Suzanne & Darcy said:
So frustrating. He’s having these good daytime cycles and such bad numbers at night. Then he gets back to work again the next day.

I hesitate to recommend an increase to 15 because he has seen some lower greens on this 14.5 unit dose. However, those lower greens were Libre sensor numbers. I see that day the Libre said 53 that you tested with the AT and got a 102. So you would have to be prepared to do tests with the AT and document them on the spreadsheet. I know you can do that. So we have a dilemma. Lower greens on this dose but are they really lower greens or even green numbers at all? I would wait at least until after tomorrow to make a decision on an increase— to see if the lower numbers return.

I am so sorry that he’s having so much trouble with his legs.
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I know! He's stressing me out...

I've updated the spreadsheet. Numbers didn't go down very far but came back up pretty quickly. He's already in the high 300s @PMPS +1.75.

Just to clarify, you want to see tomorrow's daytime numbers before deciding about increase. Is that correct?
 
He had a horrible night. Legs so weak that he didn't use litter box.

I am increasing to 15 this morning. I will watch him today.
 
Madm4444 said:
He had a horrible night. Legs so weak that he didn't use litter box.

I am increasing to 15 this morning. I will watch him today.
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This is very distressing. Perhaps you should take him to the vet. I really think y’all should have gone ahead and made the switch to Lantus. But I understand the rationale they used. :bighug:
 
Is he doing any better now that he’s coming back down into yellow numbers (and I hope will continue to come down more?)
 
Suzanne & Darcy said:
So he can walk today? Use litter box? Beautiful numbers right now.
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He has been able to walk but lies down more instead of sitting. But, amazingly, played some laser dot today! Never a dull moment!

Yes, he used the litter box to pee. Poops are still outside. Let me explain. He doesn't like the feel of litter. We've only had him since he was 4 so we're not really sure where that came from but prbly the same weird place where he got an aversion to soft things (hates any soft blankets, etc. go figure). Soo... he balances himself on the edge of the box to pee & poop. It's quite a sight. He will take one paw (reluctantly) and cover but only after he's outside of it. However, since his legs have been weaker, it's too hard to balance & push out a poop so that he does on the dropcloth next to the box. We got a box with a low entry so he could go into it but then he'd have to touch the litter so nope. That's my boy!
 
Suzanne & Darcy said:
How did you feed him this morning? How much/type of carbs and when?
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Fortunately, he ate fine this morning for his shot. I fed him FF low carb pates at AM (about 1.25 small can), then about 1/4 small can with 1.5 tsp warm water at AMPS +2.5. At AMPS +5, he got his cerenia in 1/2 chicken pill pocket & about 1+ oz of rehydrated freeze-dried chicken sprinkles in 2 oz warm water. At AMPS +9, another 1/4 small can FF with warm water. Trying to keep the ketones away with food & water...
 
Madm4444 said:
Going up. 346 on the Libre right now. I did feed him at PMPS +2. It is PMPS +3 right now. Thank you for checking in. Any thoughts for the morning?
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I would just continue with your current dose unless something really changes. He had a decent cycle today. It’s hard to say unless we know what’s coming in the morning.
 
Madm4444 said:
He has been able to walk but lies down more instead of sitting. But, amazingly, played some laser dot today! Never a dull moment!

Yes, he used the litter box to pee. Poops are still outside. Let me explain. He doesn't like the feel of litter. We've only had him since he was 4 so we're not really sure where that came from but prbly the same weird place where he got an aversion to soft things (hates any soft blankets, etc. go figure). Soo... he balances himself on the edge of the box to pee & poop. It's quite a sight. He will take one paw (reluctantly) and cover but only after he's outside of it. However, since his legs have been weaker, it's too hard to balance & push out a poop so that he does on the dropcloth next to the box. We got a box with a low entry so he could go into it but then he'd have to touch the litter so nope. That's my boy!
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Poor Buster. Where did you get him from? I wonder why he went through in his early years to make him hate litter and soft things. I wonder if the Tidy Cats Breeze system would be acceptable to him? Anyway, there are always puppy pads.
 
Suzanne & Darcy said:
Everything crossed here for Buster to have another day like yesterday.
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Hi. Buster had a similar day but lower yet. Stayed with 15 even though I was shooting PMPS 113. :nailbiting: His numbers were up near 300 by bedtime so everything seemed okay. Until Buster woke us up this morning for breakfast & we saw the Libre sensor stopped working! Yikes. AT3 check showed AMPS 399 so another high night. I almost reduced last night but he never went below 68 on the AT3 meter & I was concerned about being in the mid-400s again & about ketones, of course.

Do you think the nights are bounces from the days? If I give a lesser dose, won't he just be higher all the way around? Is this the Acro/IAA messing with me?

How is Marcus? How are your other kitties doing?
 
I think I made another mistake & missed another reduction.

I kept thinking that 68 on the AlphaTrak was the reduction trigger when it is, in fact (as I delved back into the threads), the 'possible hypo - take action' trigger.

I'm getting confused about when a reduction is earned. Is it after one cycle of low nadir or a few days in a row showing the lower numbers?
And is a reduction still appropriate if all the rest of the numbers are high?
Just when I thought I understood things... :(
 
With an Alpha Trak meter, dropping below 68 earns a reduction. Seeing a 68 means take action. What action you will take depends upon your experience and knowledge of your cat — as well as the overall trend of the numbers during the cycle (how fast has the drop been? What hour in the cycle is it, etc.) AND the caregiver’s ability to monitor the cycle. Many cats will sail along nicely in greens with just a little LC given at the “take action” point. Regardless, another test taken 15 minutes after that LC is given will tell what’s happening. Let me look at his spreadsheet and see what was happening.
 
Madm4444 said:
I'm getting confused about when a reduction is earned. Is it after one cycle of low nadir or a few days in a row showing the lower numbers?
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Buster is not a long-term diabetic (diabetic for over one year) so reductions are earned when there is a single drop below 68 on your AT meter (or below 50 on a human glucometer.)
 
And to answer your other question, yes, do believe that the higher numbers you see at night are a reaction to the lower daytime numbers. Fortunately, he usually gets back into better daytime numbers.
 
Ok. I think I understand the reduction. Since Buster did not go below 68 on the AlphaTrak, no reduction was warranted. Whew.

I don't have a human meter for glucose checks (only ketone) & I understand that is all that was available in the past but isn't the AlphaTrak closer to the real number since it's designed for the species? I know this is a sensitive subject & I don't mean anything by the question.

Buster is getting his Libre3 replaced as I type this. Fingers crossed it works. We'll know in an hour. FYI - AMPS +9 182 (AlphaTrak3).
 
Well, today was not a good one for Buster. :(
Is it possible this is a bounce?
I was really hoping to not have to mess with his dose before SRT...
 
It’s possibly a bounce. He does have this pattern where he’s done similar things before. Since you have seen low greens in this dose, if you increase, you could risk him dropping below 50. Let’s see how he does in this morning’s cycle. Also, you have seen numbers over and over again where you were supposed to have reduced. I didn’t say anything because it was clear you were doing your own thing and I also saw that Buster was in no danger and had never dropped below 50. I was happy to see those greens. My only request is that you state somewhere in your signature: Reductions at 50 since it’s “custom” dosing….. Maybe the shortest way of doing it would be to write MPM/Custom, because with MPM reductions are taken when the cat drops below 50 — so it’s implied. After the SRT, it will be very important to take reductions when they are earned and not fail to do so. I thought that Wendy had talked about a reduction point of 70 for extra safety after the SRT?
 
I was worried but he found some nice blues today. Keep him at this dose for now?

How are your kitties? How is Marcus?
 
Suzanne & Darcy said:
It’s possibly a bounce. He does have this pattern where he’s done similar things before. Since you have seen low greens in this dose, if you increase, you could risk him dropping below 50. Let’s see how he does in this morning’s cycle. Also, you have seen numbers over and over again where you were supposed to have reduced. I didn’t say anything because it was clear you were doing your own thing and I also saw that Buster was in no danger and had never dropped below 50. I was happy to see those greens. My only request is that you state somewhere in your signature: Reductions at 50 since it’s “custom” dosing….. Maybe the shortest way of doing it would be to write MPM/Custom, because with MPM reductions are taken when the cat drops below 50 — so it’s implied. After the SRT, it will be very important to take reductions when they are earned and not fail to do so. I thought that Wendy had talked about a reduction point of 70 for extra safety after the SRT?
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I revised my signature accordingly.

I am relying exclusively on this group now & it has been the best thing. I'm not sure Buster would have seen any blues or greens if you hadn't taught me about bouncing. I still get nervous b/c of the DKA threat but am learning to trust the process.

I would very much like to get a clear protocol for him post-SRT. He will still have the Libre and I still have the AlphaTrak3 for checks.

@Wendy&Neko is 70 (instead of 50) on the Libre the safest reduction point post-SRT?
Is there a corresponding number for the AlphaTrak3 (or is that just confusing the issue)?

Thank you, ladies!
 
Madm4444 said:
is 70 (instead of 50) on the Libre the safest reduction point post-SRT?
Is there a corresponding number for the AlphaTrak3 (or is that just confusing the issue)?
Click to expand...
70 on a human blood glucose meter was the number suggested to me by the folks at CSU, and is seems to work. I have no clue what that means on your Libre or the AT. We've seen quite varying differences between the Libre and blood glucose meters (AT or human) between our different members. There is no conversion rate. Have you done comparisons between the Libre and your AT? If so, maybe put together a table of the differences to see if you can see pattern.

Same for AT vs human meter - comparisons in lower numbers have shown that the human meter generally shows a lower number than the human meter, unless it doesn't. Meaning I've seen the other way too.
 
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