? Dosing plan for "almost" diet-controlled?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Kerri & Tigger, Jan 25, 2020.

  1. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Hi Friends,
    No rush to respond; I see that the board has been busy, and I know that some of our mentors are away for a bit. But when someone has a chance, I would love an extra set of eyes on Tigger's chart.

    She was diagnosed in Dec. 2019 and started on Vetsulin. Now that we've cleared up a nasty UTI (antibiotics in Nov. & Dec.) and switched from high carb to low carb diet, she's flirting with normal numbers. . . . Most of the time. I have skipped a lot of doses and (I think probably wrongly) never tapered down with the 0.1 and "drop" doses.

    Some key recent dates are 1/21/20, 1/22/20, and 1/23/20. The fact that she dropped into 80s (cat meter) with no insulin has me hesitant to shoot, especially with history of hypo at the beginning of all this. (Most recently, 1/10/20 was trending hypo, but we steered up with gravy food.) But now Tigger also does some hovering around 150s and it feels like she should be nudged a bit lower. Also she sometimes has little spikes that I can't explain.

    In short, I never quite figured out a good shoot/no shoot/ dosing protocol once we settled into the blue with forays into greens (and the occasional yellow).

    Side note--if you look far back in our chart, there are a few days in the end of Dec. where I was using human meter, when AlphaTrak strips were delayed in shipping. I tried to flag that clearly with orange marker in left-hand column and "HM" next to numbers. Everything else is AlphaTrak2.

    Thanks in advance for help! You all have already done so much for Tigger and me. :bighug:
     
  2. Juls and Billy

    Juls and Billy Member

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    Dec 28, 2019
    Hello Kerri! I'm too much of a newbie to give dosing advice, or advice on what numbers are best to shoot on. I'm sure someone more experienced will be in soon. I just wanted to say that you rock, and Tigger certainly looks to be headed for remission. I think your drop dose plan has merit and one of the more experienced members should be able to help you with it.
     
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  3. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Thanks, Juls! You have been super-supportive to all of us since you joined! :)
     
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  4. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    Here is my suggestion: since our methods were all developed using a human meter and there is no equivalence between human meters and pet meters, I would suggest you switch to your human meter. That way, we can see where Tigger is in relation to the methods we use so we can better advice you.
    As an example, on the days you were using a human meter, Tigger was in all green quite a bit of time. We could get a better feel for where he actually is and whether you should try a drop of insulin or not. Would that be possible?

    The dosing protocol would be Start Low Go Slow which would mean you wouldn’t shoot anything below 90. Because you’ve been skipping almost all shots below 150 on an AT, you might start there on a human meter and shoot a 150 or above with one drop as long as you will be there to test and you have supplies. See what he does and if the drop is too much, then you probably don’t want to shoot too much lower than that but if he stays flat blue, you might try to shoot 140 next time, etc. In other words, don’t go from skipping shots to shooting everything above 90. I would approach it very slowly and cautiously. But first, I’d try the human meter and do things as you’ve been doing. Test and see where he is and how long he stays in green without insulin.
     
  5. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Thanks so much, Marje! I can definitely switch meters. And I'm all for slow and cautious....I'll switch back to the human meter in the morning. I appreciate you looking over Tigger's numbers!
     
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  6. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Hi Friends,
    I'm checking back in with 10 days of fresh data with my human meter. . . . Not much green; more low-to-middle blue. Seems like if 150 is my spot to try a micro-dose, Tigger tends not to quite get there (or at least not around our old shot times). Any advice for nudging her numbers down? Or should I continue my holding pattern?
    Thank you all!
    Kerri
     
  7. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Take away the Young Again Zero.
    Why? Because some cats actually do better with a bit more carb in their diets.

    You could at least try feeding without the YA Zero for at least a week, maybe 2 weeks. See what it does to help the BG readings.
    Discussion was in this thread, from an group that was outside of FDMB. Vet Dr Lisa Pierson was part of the discussion.
    Feeding Lowest/Zero Carb vs Lower Carb Foods
     
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  8. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Thank you, Deb! I will definitely give that a try; I was a little nervous about the YAZ anyway. (And Tigger seems to like Dr. Elsey's better; she'll like having that in the treat jar.) I can also start keeping a better eye on the wet food carb levels. She was a dry food junkie, and I have been rotating wet flavors / kinds a lot to find what she will eat. My house has started to look like a low-carb cat buffet. Anyway, I'm realizing that some of my go-to's have been super low carb; I can try working in the Friskies pates more consistently. She's started to have a taste for them, thankfully! :) Thank you again!
     
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  9. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Different foods, different insulins, different suggestions/ideas/brainstorming.

    We never know what will make a difference in your cats diabetic journey.
    "Know thy Cat" is a saying that Jill & Alex (GA) coined many years ago. Unfortunately, she is no longer with us but we still rely on much of the information that she put together.

    My main "go to" reference is the Health Links/FAQS forum and looking in the Index sticky at the top for articles. Then I look at the "Sticky" in the ISG forums and try to link pertinent information into threads that I think may help people.

    You never know what is going to be useful information to someone. Only yesterday, I realized that an Argentina member was looking for insulin syringes with 1/4 unit markings on the barrel. Explained there were only U100 syringes with 1/2 unit markings. U40 syringes also exist with 1/2 unit markings on the barrel.

    The misunderstanding was partially the language barrier, partially my poor and incomplete explanation. I'm always afraid that I'll leave out some critical piece of information. But the flip side is overwhelming a new member with too much information. Still trying to find a balance with helping people and their diabetic cats, after my own 7+ years of experience with a few of my own diabetic cats. It's a balancing act.

    All of us helping, mentoring, assisting, guiding, suggesting, brainstorming are doing the best we can with the limited number of volunteers that we have here.
     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Kerri. Making notes in the Remarks column on your SS (spreadsheet) of what foods you are feeding may help you and us also. I do look at the SS before commenting on a post/thread. I also look at the signature data to see what insulin/meter used and any other health issues.

    Tigger is so darn close to being diet controlled (remission, OTJ) but not quite there yet.

    I realize she is not on insulin, too low to shoot and too many blue BG numbers for her to be considered diet controlled - yet.

    Have you ever considered using U100 syringes with the Vetsulin U40 strength insulin? Still difficult to measure, but you can give really tiny doses of a U40 insulin with U100 syringes. It's an advanced technique. Not often used.
    Let me know if you would like more information.

    p.s. Wink was a dry food addict also. I sometimes say he was a charter member and founder of DFAA (Dry Food Addicts Anonymous).
     
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  11. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Hi Deb,
    Thank you for all of this--I have been lurking a lot; the FDMB is addictive! :) --and I have seen you (and others, of course) committing so much time and care to this community. What an amazing space and group of people. And what a way to honor your sweet Wink; I have loved reading about his journey, and his gorgeous tail! And I have especially followed Teo's thread; Viamo is a lucky kitty, isn't he?

    I will definitely start layering in the puzzle pieces of what Tigger is eating on my SS. I wish I had been doing that all along. . . . I remember for a while I was mixing in some moderate carb (a flavor of Nutrish that Tigger loves) into some of the 0-1 carb options to coax her into eating. (I read about someone trying something similar on the link you shared with me, too.) I wonder if that might have been when I was getting more greens, but since I didn't write it down, I don't know. Lesson learned--I'll start note-taking!

    Also, I'd seen some others receive the suggestion about U100 syringes. I studied the conversion chart and it made clear sense to me....So I bought some U100s--but I goofed and forgot to choose ones with half-unit markings. I experimented with colored water and feel like I could see roughly .2, .1, and one drop....(Squirting out on paper towel to compare splotches.) But then I haven't been dosing. I'd be happy to repurchase with half-unit marks if we need to settle back into dosing.

    I suppose that's it for the moment; I'll kick-off Tigger's food journal journey now! :)

    Grateful, hopeful, and sending good thoughts to all the sugarcats and parents out there.

    K
     
  12. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Hmm--Deb--if you happen to be around--highest reading tonight that I've had in a while (up to 175 at what would be PMPS). Maybe the Young Again "treats" were actually helping? (I treat a good bit; I would say Tigger was getting a tablespoon of YA each day, spread out.)

    I'm wondering if it's time for a small dose tonight or if I just hold what I've got? (I also think Tigger nibbled less than usual while I was at work today. She had food available, but sometimes it's just not what she wants. Maybe her supper will bring BG down....)
     
  13. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    You think you could do 1 drop? Are you around to monitor tonight? I can't stay up with you to help you. Past my normal bedtime already.

    Draw up the tiniest bit of insulin you can, push as much of the air out towards the needle end of the syringe as you can with that 'finger flick'. Twist the plunger sslooooowwwly to squeeze out most of the insulin until you have a tiny drop at the end of the needle. Then draw back on the plunger to "suck' that tiny bit back into the syringe. Give Tigger the insulin.

    Not eating well the past 2 days is a bit worrying.

    Too early to tell on the YA treats. It takes about 3 days for dry food to pass through the digestive system.

    Keep recording notes on the food in the SS Remarks column.
     
  14. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Do you have any Alphatrak test strips left?
     
  15. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Thank you, Deb! Yes, I have Alphatrak strips. She was at 237 on AT when I got the 175 on my human meter.

    More in a moment on your other note....
     
  16. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    I can definitely try a 1-drop dose--that sounds like a good plan to me. And I'm around all night, have supplies, am confident I can keep away a crisis. It's been about an hour since she had supper; I didn't update the supper info on chart, but I will. She ate normally, her Friskies pate. (Never lots--she is just such a grazer--but normally tonight.) I'll try another test now and double-check how things look.
     
  17. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    161 human / 207 AT at +1.5 since last test and hour since supper. So that's nice to see.

    Thank you so much for your reply, Deb--and I hope you've headed to bed or will soon. I will try a drop tonight and will keep a close eye.
     
  18. Deb & Wink

    Deb & Wink Well-Known Member

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  19. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Thank you! And your directions were perfect....I tried a few practice runs first to be sure I was really getting "down to the last drop." And the sucking-back-into-syringe worked great. Tigger had her drop, another little snack, and is enjoying some fresh air on the patio. I think we are all set but I will be sure to check BG and keep a close eye. Grateful to you!
     
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  20. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    After this morning's litterbox scooping, I'm sure Tigger has been constipated. I scoop every morning--usually get 3 or 4 pee spots and one nice poop every 24 hours. This morning, her poo was a quarter the normal size. (I also spotted some grass nibbling while we were outside this morning.) Have a hunch the YAZ treats have been a steady light laxative. I just gave her some pumpkin in some warm fish juice and she drank it all up; maybe that will loosen things up. (Have read on here about Miralax, so if poo problems continue that can be a backup.) Brother dog gets a bit of pumpkin every day, so maybe pumpkin works for Tigger too.
     
  21. Deb & Wink

    Deb & Wink Well-Known Member

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    What do you think of doing another drop of insulin for PM cycle?

    Tigger is still to high to be considered diet controlled.
     
  22. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Oh absolutely! I was wondering about giving her one this morning but I wasn't sure.... She has plenty of food in her at the moment; I could even do one now. (I have some AM/PM flexibility for the next few days, so time of day is not a problem.)
     
  23. Deb & Wink

    Deb & Wink Well-Known Member

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    How many + hours is it after your normal AMPS test time?
     
  24. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    It's 2 1/2 hours after that.
     
  25. Deb & Wink

    Deb & Wink Well-Known Member

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    1 drop now. Test again first.
     
  26. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Will do. More in a moment. Thank you!
     
  27. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    151 human / 197 AT. She has had her drop. Will be checking to see if it does enough, too much, etc.
    Big thank you as always!
     
  28. Deb & Wink

    Deb & Wink Well-Known Member

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    Monitor her closely.
    Keep the SS updated.
    You're going to be using a lot of test strips for the drop dosing.
    Do you have plenty on hand?
     
  29. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    I do have lots of strips, both kinds. (One new and one almost-new container of each kind.) You can see I started using both monitors last night (I wasn't sure when you asked about the Alphatrak whether I should be using it instead/too.) Do you have a recommendation or preference?
     
  30. Deb & Wink

    Deb & Wink Well-Known Member

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    For now, if you can parallel test with both meters, I'd like you to do that.

    Alphatrak can be more accurate at the lower BG numbers since it's calibrated for feline blood.
    Human meter is good enough when the BG readings are higher.
    We're trying teeny tiny doses to bring Tigger's numbers down a fraction.
    I think we need the Alphatrak numbers more right now.

    Is Tigger cooperative with the testing process?
     
  31. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Yes--she is very easy to test. I can definitely keep parallel testing. And I'm happy to use the AlphaTrak however much I need to. Pricey strips are not a problem (luckily). I've gotten better at "sipping" the blood on my Relion, but the AT is sooooo easy, wants almost no blood. I love using it.

    Thank you so much for helping us, Deb. I have been feeling like I needed to move into these low doses for a while, like I was kind of leaving Tigger in a not-terrible but not-great limbo by not trying these.
     
  32. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Let's go with the Alphatrak then. No need to do both meters at this point.
    Only keep track of the fact that you are using the AT since the SS needs the correct meter for the test results.

    Like you did on the SS for 2/7/20 PM testing.
    We simply want to see which meter was used for future reference.
    SS is going to get a bit 'unconventional' shall we say?
     
  33. Kerri & Tigger

    Kerri & Tigger Member

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    YAY. That sounds great to me and Tigger too! She hardly even knows I'm doing an AT test. :) And my SS was already looking a little wonky, I think. But I will jump in and be sure it's easy for everyone to see what's what.
     
  34. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    The 1 drop is bringing him down a bit.
    Tigger still seems a tiny bit high on the 1 drop of Vetsulin.
    Do you think you could measure 2 drops with those U100 insulin syringes you have been using for this U40 insulin?

    If you are around to monitor, you might consider that teeny tiny increase.

    Those Alphatrak pet meters really have their uses when you are microdosing like this and trying to bring the numbers down a bit. I know that the test strip cost can be high for some people. But the pet meters are made to measure feline blood and do it a bit more accurately than a human meter would.

    I just watched a video showing someone put a FSL (Freestyle Libre) CGM (continuous glucose monitor) on their cat. You actually need a bit of superglue? to keep it on and then cat needs to stay in a "onesie" to keep them from scratching and dislodging it.
     
  35. Kerri & Tigger

    Kerri & Tigger Member

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    Thanks so much for looking in on us today! I was wondering exactly that, about 2 drops. I do see how to measure that much from my U100 syringes. (I just tried a few test runs with some of that red liquid that that came with my meter. I forgot what it's called, calibration fluid?)

    I'm home all night tonight and can be around in the morning until about +3.5. And it's easy to leave food out through the day; Tigger is an only cat, and her dog brother leaves the cat food alone. (Miracle of miracles, sweet good dog.)

    Would you mind helping me with a contingency plan? Like, if PMPS is __ or less, stick with 1 drop? I was thinking maybe if 130 or less, just give a drop. If higher, try 2? [my latest reading was 133 at +6, just got that added, but PMPS is still a long way off, I realize.
     
  36. Kerri & Tigger

    Kerri & Tigger Member

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    I do love the AT! No superglue required. Thankfully, Tigger is easy to test--but I have a feeling she would draw the line at the onesie. I think we'd need superglue + onesie + about a roll of duct tape. :D
     
  37. Deb & Wink

    Deb & Wink Well-Known Member

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    The liquid stuff that comes with the Alphatrak meter is control solution. It has a set amount of glucose in the bottle, and when you test, the meter knows what the reading should say. It's a way to test your meter and sort of "calibrate it". Only lasts 3 months once opened, so fine to use for practicing with the drop dosing.

    You can always test yourself too. Remember to do that 2 hour fast, to get a baseline BG for yourself. :)

    Ah, yes. More advanced techniques for using some of those in and out insulins like Prozinc and the Vetsulin you use. The one you are suggesting is often called "sliding scale" dosing.

    Where you are giving insulin doses by the BG numbers, instead of a set dose of insulin each time. Not to be used by those first starting out with ANY insulin, nor for those using the "depot" type insulins like lantus or levimir. Would not use it with NPH either, because of the steep and rapid drops, like riding on the worlds fastest roller coaster, the Formula Rossa in the UAE.

    It may take a little time to adjust this type of specific "sliding scale" to a Tigger only dosing plan. DO NOT COPY DOSING ADVICE in your signature would be good. I'd rather be a bit more conservative for now.

    How many drops do you get from the U100 syringes if you draw the liquid up to the 0.25 unit "line"? Practice, practice, practice until you get a consistent number of drops. Maybe use grape or apple juice in your "practice syringe" Then let me know. Before we attempt to develop a sliding scale for Tigger.

    Would you be willing to move over to the Caninsulin / Vetsulin and N / NPH ISG (Insulin Support Group)? I'd know to look for you there. If so, copy the link to this post here as the first item you have in the new thread over there.

    Love this thought! What color and pattern? I have duct tape in purple, fluorescent orange, white, the old blah gray and real duct tape which is the silver foil kind. Only living thing I've used it on is to mark a few of my flower stalks, so I'd know what color they were after they were done flowering. So I could dig them up for gardening friends.
     
  38. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Yes to all of that! I've just posted in the other forum.
     
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