Tipsy dosing advice needed

[Tipsy]

Hi folks it’s been a long time since I’ve posted to the FDMB. Firstly criticism about my testing frequency will not be welcomed, I have several disabilities and am doing the best I can with limited time and limited budget. Test strips are expensive in Australia and I can’t really afford to test more often plus I’m often at work during his nadir.

I need some dosing advice. I’m not sure if I’ve missed the dosing window for Tipsy or if I need to increase. His levels bounce all over the place, nadir at the last curve was 9.4mmol [169mgdl) a few days before that his nadir was 4.9mmol (88mgdl). His pre-shot numbers are almost consistently high. According to the SLGS dosing method I should have increased from the last curve but given he had been in normal levels at nadir a few days before I’m not sure what to do. Links to his spreadsheets are below. He is on Fancy Feast pates morning and night with chicken jerky around midday.

New spreadsheet
https://docs.google.com/spreadsheets/d/1ZL4lLQwa76npsXkHHCrdK0bED91_CXunp1g5iv8UmKU/edit

old spreadsheet
https://docs.google.com/spreadsheets/d/1kxBhvLDt7Nvobsl8S7s2IGJdr4nwGwUdL5-6O9Kl9rM/edit

 

[Scdal]

Hi folks it’s been a long time since I’ve posted to the FDMB. Firstly criticism about my testing frequency will not be welcomed, I have several disabilities and am doing the best I can with limited time and limited budget. Test strips are expensive in Australia and I can’t really afford to test more often plus I’m often at work during his nadir.

I need some dosing advice. I’m not sure if I’ve missed the dosing window for Tipsy or if I need to increase. His levels bounce all over the place, nadir at the last curve was 9.4mmol [169mgdl) a few days before that his nadir was 4.9mmol (88mgdl). His pre-shot numbers are almost consistently high. According to the SLGS dosing method I should have increased from the last curve but given he had been in normal levels at nadir a few days before I’m not sure what to do. Links to his spreadsheets are below. He is on Fancy Feast pates morning and night with chicken jerky around midday.

New spreadsheet
https://docs.google.com/spreadsheets/d/1ZL4lLQwa76npsXkHHCrdK0bED91_CXunp1g5iv8UmKU/edit

old spreadsheet
https://docs.google.com/spreadsheets/d/1kxBhvLDt7Nvobsl8S7s2IGJdr4nwGwUdL5-6O9Kl9rM/edit

I wish I could help you but I don't have any experience. I sympathize that no one has answered your post. This website is supposed to about helping our cats and not about petty differences. I hope Tipsy is doing okay. Hopefully, someone will respond to your post soon. Good Luck to you both.

 

[FrostD]

This is not a criticism, just a statement - I'm not comfortable saying increase because of the lack of tests. Based on the curve you did I agree, it does look like you have room. BUT you caught those two greens, which makes me think there's be more on cycles you don't test...in which case it's safer to hold the dose.

How is he clinically?

 

[Christie & Maverick]

I have a couple of thoughts. With SLGS you want to evaluate the current dose every 7 days, and run a curve, but if during that time you catch any number under 90, that would actually earn a reduction in dose. You had some numbers under 90 that actually called for reduction.

When evaluating a dose, you want to ask yourself, how low is this dose taking Tipsy? Ideally, even a few spot checks at night here and there can help fill in some of the missing pieces, I'm not sure if that is doable, perhaps a before bed test now and again? At the moment, you've got only half the puzzle.

Nadirs can, and do move around, they aren't always at +6. One of my favourite sayings by Sienne about her cat Gabby is that "Gabby's nadirs were around +3 except for when they weren't". I noticed you mentioned meals am and pm and jerky at midday. Sometimes kitties who bounce can benefit from getting some low carb snacks early in the cycle, to help slow down the drop. This post gives some info, if that is something you are interested in trying. Using food to manipulate the curve

 

[Tipsy]

This is not a criticism, just a statement - I'm not comfortable saying increase because of the lack of tests. Based on the curve you did I agree, it does look like you have room. BUT you caught those two greens, which makes me think there's be more on cycles you don't test...in which case it's safer to hold the dose.

How is he clinically?

For the reasons started in my original post it’s not possible for me to do weekly curves, I’m doing the best I can.

 

[Tipsy]

I have a couple of thoughts. With SLGS you want to evaluate the current dose every 7 days, and run a curve, but if during that time you catch any number under 90, that would actually earn a reduction in dose. You had some numbers under 90 that actually called for reduction.

When evaluating a dose, you want to ask yourself, how low is this dose taking Tipsy? Ideally, even a few spot checks at night here and there can help fill in some of the missing pieces, I'm not sure if that is doable, perhaps a before bed test now and again? At the moment, you've got only half the puzzle.

Nadirs can, and do move around, they aren't always at +6. One of my favourite sayings by Sienne about her cat Gabby is that "Gabby's nadirs were around +3 except for when they weren't". I noticed you mentioned meals am and pm and jerky at midday. Sometimes kitties who bounce can benefit from getting some low carb snacks early in the cycle, to help slow down the drop. This post gives some info, if that is something you are interested in trying. Using food to manipulate the curve

for the reasons started In my post it’s not possible to run weekly curves. Sometimes I also simply cannot afford test strips which is why a lot of the time I can only do pre shot testing. My husband is a needle phobe and refuses to do tests or injections while I’m out of the house so this also makes things tricky. I have just brought an auto feeder which I will set up to feed Tipsy jerky and Ziwipeak at regular intervals through the day and night.

 

[Christie & Maverick]

Understood, I was clarifying the basic SLGS guideline, since it can often happen that other members who don't post about their cat, but just read the forum information will come along. I'd still suggest before increasing that you get some tests to determine how low the current dose is taking Tipsy. That may mean holding the dose a little longer just to be sure it is safe to increase. I appreciate you are doing the best you can, any mid cycle tests you can get will help determine how low the dose is taking Tipsy.

As I said before, when contemplating increasing the dose, you want to ask yourself "how low is this dose taking kitty". I see you increased to 2.5u, my suggestion would have been to try and do some on mid cycles tests for a couple of days, before doing so, since we make dose decisions based on nadirs, not preshots.

Info- should I increase dose?

Great that you have an autofeeder, I love mine!

 

[FrostD]

For the reasons started in my original post it’s not possible for me to do weekly curves, I’m doing the best I can.

I understand that, I was just giving my thoughts on increase vs hold vs decrease. I'm also asking how he seems in general - Good health? Any issues?

 

[Scdal]

for the reasons started In my post it’s not possible to run weekly curves. Sometimes I also simply cannot afford test strips which is why a lot of the time I can only do pre shot testing. My husband is a needle phobe and refuses to do tests or injections while I’m out of the house so this also makes things tricky. I have just brought an auto feeder which I will set up to feed Tipsy jerky and Ziwipeak at regular intervals through the day and night.

I was just looking online at the cost of test strips in Australia. They are $60 for a box of 100. Over here, they are about $17. Your lancets are $10 for a box of 100, here they are about $1.50. I can see why you limit the number of test strips you use. I can go through a box of 100 test strips in one week.

Does you or anyone on this forum know if you can send these through the mail or would they be confiscated by the import regulations? If possible, I would be happy to send you a Relion monitor, test strips and lancets. This would be a Christmas present for Tipsy.

 

[Sienne and Gabby (GA)]

@Bron and Sheba (GA) is in Australia. She may have some insights on less costly options.

 

[Bron and Sheba (GA)]

Hi @Tipsy
Where are you buying your test strips at the moment?. And how much are they costing? They will always cost more at the chemist than online. I have always found the online sources to be very reliable.
I will send you some links to some tests strips that looks very reasonable to me….cost wise..
Also on the same page there are usually other options to buy the same product at different prices.
What do you think?

https://www.davidjonespharmacy.com.au/abbott-freestyle-lite-blood-glucose-test-strips-10

https://www.ebay.com.au/itm/Abbott-Freestyle-LITE-Glucose-Test-Strips-100-Tests-/123880451710

https://www.ebay.com.au/itm/1437060...efaultOrganicWeb&_trksid=p2047675.c101224.m-1

 

[Tipsy]

Understood, I was clarifying the basic SLGS guideline, since it can often happen that other members who don't post about their cat, but just read the forum information will come along. I'd still suggest before increasing that you get some tests to determine how low the current dose is taking Tipsy. That may mean holding the dose a little longer just to be sure it is safe to increase. I appreciate you are doing the best you can, any mid cycle tests you can get will help determine how low the dose is taking Tipsy.

As I said before, when contemplating increasing the dose, you want to ask yourself "how low is this dose taking kitty". I see you increased to 2.5u, my suggestion would have been to try and do some on mid cycles tests for a couple of days, before doing so, since we make dose decisions based on nadirs, not preshots.

Info- should I increase dose?

Great that you have an autofeeder, I love mine!

hi there sorry for the delay in replying, I got busy with having my own major dental work over the past fortnight and forgot to check back in. I’ve done another curve this week for the 2.5U dose if you’d like to check out Tipsy’s spreadsheet again. I’m actually thinking of dropping back to the 2.25 dose as his nadirs and curve on the 2.5U dose weren’t great and I think I’ve now gone above his dosing window.

 

[Tipsy]

I understand that, I was just giving my thoughts on increase vs hold vs decrease. I'm also asking how he seems in general - Good health? Any issues?

Hi Frost sorry for the delayed reply got caught up with other things and forgot to check back in. Other than peripheral neuropathy in his back legs which he has had since January he is doing well. No other health issues

 

[Tipsy]

I was just looking online at the cost of test strips in Australia. They are $60 for a box of 100. Over here, they are about $17. Your lancets are $10 for a box of 100, here they are about $1.50. I can see why you limit the number of test strips you use. I can go through a box of 100 test strips in one week.

Does you or anyone on this forum know if you can send these through the mail or would they be confiscated by the import regulations? If possible, I would be happy to send you a Relion monitor, test strips and lancets. This would be a Christmas present for Tipsy.

Hi Scdal, that’s so generous of you! I’m not too sure about whether Australian Customs would cease test supplies from the US. The postage costs from the US to Australia are quite high at the moment due to Covid and I know some carriers have halted postage to Australia completely.

 

[Tipsy]

Hi @Tipsy
Where are you buying your test strips at the moment?. And how much are they costing? They will always cost more at the chemist than online. I have always found the online sources to be very reliable.
I will send you some links to some tests strips that looks very reasonable to me….cost wise..
Also on the same page there are usually other options to buy the same product at different prices.
What do you think?

https://www.davidjonespharmacy.com.au/abbott-freestyle-lite-blood-glucose-test-strips-10

https://www.ebay.com.au/itm/Abbott-Freestyle-LITE-Glucose-Test-Strips-100-Tests-/123880451710

https://www.ebay.com.au/itm/143706037566?_trkparms=amclksrc=ITM&aid=1110006&algo=HOMESPLICE.SIM&ao=1&asc=20200818143230&meid=77ada93101774f72b30a7bcedb726173&pid=101224&rk=3&rkt=5&sd=123880451710&itm=143706037566&pmt=1&noa=1&pg=2047675&algv=DefaultOrganicWeb&_trksid=p2047675.c101224.m-1

Hi Bron sorry for the late reply. The last test strips I got from Amazon AU for $36 and previous ones I’ve brought have been from SuperPharmacy Plus and Pharmacy Direct however both of those are on the other side of the country to me and can take up to 3 weeks to arrive due to Covid restrictions. The Amazon strips arrived in 3 days! Given the speed of the Amazon strips and the fact I get free postage as a Amazon Prime customer I think I’ll stick with them for now.

 

[FrostD]

Your spreadsheet is not updating for me. If you click the link in your signature, does it show the up to date spreadsheet? Sometimes Google sheets just doesn't cooperate on my phone

 

[Little Man's mom (GA)]

Your spreadsheet is not updating for me. If you click the link in your signature, does it show the up to date spreadsheet? Sometimes Google sheets just doesn't cooperate on my phone

I've noticed having issues with ss on phone as well and may have figured out why.

If we look at others spreadsheets to help with dosing or just see where others are going with numbers it saves whatever we open within our google sheets. I couldnt record numbers on my own ss became view only. Tried everything reboot phone...close app etc... finally in last ditch effort I deleted any ss that wasnt mine. Once I did this I could again record numbers.

Could have been a fluke and it just randomly started working but worth a shot?

 

[FrostD]

I've noticed having issues with ss on phone as well and may have figured out why.

If we look at others spreadsheets to help with dosing or just see where others are going with numbers it saves whatever we open within our google sheets. I couldnt record numbers on my own ss became view only. Tried everything reboot phone...close app etc... finally in last ditch effort I deleted any ss that wasnt mine. Once I did this I could again record numbers.

Could have been a fluke and it just randomly started working but worth a shot?

Yeah usually it's just "stuck" at the last time I opened someone's SS and if I wait it'll tell me it's changed a lot and to reload. Not this time! I'll probably delete Tipsy s and see if that'll trigger it

As for the view only on your own SS - The fastest fix I found was to change your "anyone with the link can..." sharing settings to something else like Comment, let it save the change. Then change it back to View. When you get back to the SS sometimes itll tell you to reload, otherwise just close it and reopen it. It's a pain, but better than reinstalling and deleting stuff

 

[FrostD]

hi there sorry for the delay in replying, I got busy with having my own major dental work over the past fortnight and forgot to check back in. I’ve done another curve this week for the 2.5U dose if you’d like to check out Tipsy’s spreadsheet again. I’m actually thinking of dropping back to the 2.25 dose as his nadirs and curve on the 2.5U dose weren’t great and I think I’ve now gone above his dosing window.

Ok I finally got it fixed. Why do you think you've gone too high?

You haven't seen anything below yellow numbers. He's been consistently yellow and pink, which tells me he needs an increase of 0.25U.

If you had gone too high, he would be bouncing - I don't see any indication of that. His spreadsheet would look much more inconsistent, higher pinks and possibly reds. But he's pretty flat!

 

[Tipsy]

Your spreadsheet is not updating for me. If you click the link in your signature, does it show the up to date spreadsheet? Sometimes Google sheets just doesn't cooperate on my phone

Whoops sorry my up to date spreadsheet is in my original post, hadn’t updated to my signature yet.

 

[Tipsy]

Ok I finally got it fixed. Why do you think you've gone too high?

You haven't seen anything below yellow numbers. He's been consistently yellow and pink, which tells me he needs an increase of 0.25U.

If you had gone too high, he would be bouncing - I don't see any indication of that. His spreadsheet would look much more inconsistent, higher pinks and possibly reds. But he's pretty flat!

I was thinking maybe I’d gone past his window as when on 2.25u he did have a couple numbers in the green zone

 

[FrostD]

I was thinking maybe I’d gone past his window as when on 2.25u he did have a couple numbers in the green zone

I think since then some glucose toxicity has built up because the doses are being held too long (I do remember your circumstances, it's just a statement not a criticism). So you will have to keep increasing every chance you get to break through some of that, and when you do break through he should come back down

 

[Tipsy]

I think since then some glucose toxicity has built up because the doses are being held too long (I do remember your circumstances, it's just a statement not a criticism). So you will have to keep increasing every chance you get to break through some of that, and when you do break through he should come back down

ok thanks for explaining that, I’ll increase tonight to 2.75 and see how that goes