PMPS lower than "nadirs"?

A week ago (7/13), we did a curve, and while it seemed perhaps a touch "right-shifted," it was still more or less recognizable as a "curve." Next day also made sense. But 7/15, her +11 was lower (only by 8, but still!) than her +6, and since then. the six days for which we have an AM mid-cycle number have a PMPS *lower* than where we would expect the so-called "nadir" (i.e., lower than the BG at +6).

Even if we ignore yesterday's where the +6 and +12 were for all intents and purposes the same, does this make any sense to anyone? We did two stalls this PM and eventually decided not to shoot as she was lower with each test and at 75% of her +6 number and ~50% of her AMPS. Which . . . what?!?

(I wouldn't be complaining, of course, if all those numbers were greens instead of first yellows and now blues!)

 

The rule to not shoot under 200 is only when you're new and not comfortable testing, or when your schedule doesn't allow you to monitor and make sure Josie is safe. At this point, I would recommend that you go ahead and shoot on those blues. If you're not comfortable with that at first, you can try giving a partial dose. You can see from last night that she was back up in the yellows by +3. When a cat is having a good response to Prozinc, it can last about 14 hours. Then the next dose kicks in around +2, so when you are shooting consistently, what ends up happening is you are able to bring those PS numbers down and keep Josie in healthier numbers all day long.

It doesn't work for all cats. There are cats that will dive into low numbers, but from the data we have so far, Josie looks like she would likely be okay. Of course the only way to know is to try it, and to be ready to give some extra food, or some higher carb food, to keep her numbers in the dark greens if necessary.

Next time she gives you a PS like that, and the stall doesn't work, try shooting 1u instead of skipping. Then the next time try 1.25u, etc.

You can also take into consideration just how low the blue is. For example, there is a meaningful difference between a 170 and a 120, so if it's a 170, you can try something closer to the regular dose, if it's a 120, you might want to try something on the smaller side, at least at first. (those numbers are just examples, there isn't anything magical about 120 vs 170 ).

You might find it helpful to take a look at some other people's spreadsheets to get a sense of how that works. And you can always post and ask for help so you aren't going it alone the first time you try that.

 

I did not know that! I thought the effect was pretty much over by ~+11. An effect nearing 14 hours would certainly explain the right-shift we've been seeing in her nadir throughout the AM cycles. (And maybe in the PM, but I don't have data for that.)

We will definitely do this. I think maybe I need to be a little braver.

Is this the "sliding scale" protocol we've read about on the sticky?

 

In a sliding scale approach, you set ranges, and then give a particular dose depending on the ranges. It almost never works over the long run.

However, the difference between that and what I was suggesting may be semantics to some extent. I was suggesting more of a trial-and-error experiment, rather than static dosing ranges. And of course this changes over time because our kitties don't like to make this easy for us! So you would lower the dose just because you haven't shot on lower numbers before. Then you would collect data, and decide if next time you could give more insulin, or if the reduced dose was needed. Assuming the number held steady, then next time you would give more.

If you look at my spreadsheet for the PM cycle on 7/20, you can see how poorly reducing the dose works for some cats. Sam gave me a really low PS and I reduced his dose. He ended up rising instead of dropping (he has a very early PM nadir - usually around +3). <<Please don't look too closely at my dosing over the past week or so: Sam was in for a dental cleaning and it takes him a little while to settle down after anesthesia, so my dosing has been wonky to say the least.>> So on that cycle, I should have given him the full dose despite what his PMPS looked like. Even after being here for so long, I still chicken out sometimes.

 

Thanks, Djamila. The distinction does make sense, and it looks like I may get the opportunity today to try it out since the little stinker just gave me a 121 after a terrible yesterday (expected after the no shot, but I still hated to see those numbers!). 123 after 20 min, and we're starting stall #2 . . .

 

Good job with your dose this morning. Now fingers crossed she holds steady and gives you some good numbers!

 

Thanks, Djamila. It is a little nerve-wracking , but I will be glad to know more here in a few hours.

 

I'm curious too! Just remember that even if she heads lower, you have the tools to keep her perfectly safe. The worst that can happen is she gets some extra snacks and a few extra pokes.

 

72 at +4. Gave her 1/2 can of LC FF, which she ate almost all of before deciding to give her face a thorough wash.

 

Well now, that's almost identical to Sam's cycle last night! Looks like she handled that reduction really well, and also that the reduction on that number was the right thing to do. Make a little note for yourself for next time. No guarantees that the same thing happens next time, but it gives you an idea of where to start.

 

PS - that also tells you that she might have been okay without both stalls. So next time you could try stalling once and then shoot. The other thing we want to watch for is her PMPS tonight. Does the reduction leave her with too little insulin and a high PMPS? or is she able to work the insulin long enough to stay in normal numbers? If she ends up on the high-normal end, she maybe could have handled 1u without really dropping much more - it just might have had longer duration. If her PMPS is good though, then the 0.75u was the right amount. So many things to consider in this dance!

 

Sooooo true!

One thing I'm not clear on: is tonight's PMPS at her *regular* time (which is effectively +11 since we stalled twice this AM), or is it truly at +12 from this morning's shot. <--- and if truly +12, do we get back on schedule by shifting up 15 minutes at the beginning of every cycle?

(P.S. Her +5 was 69, so holding steady.)

 

That's a great question. The answer is: it depends.

You can try testing her at +11 and see if she's high enough to shoot. If she is, you can go ahead and give her insulin at that point and be back on schedule. If she's not high enough to shoot, you'd need to wait until +11.5 or +12 or whenever she's ready for it.

"High enough to shoot" is a bit relative as well since this morning you were able to safely shoot on a pretty low number, just at a reduced dose. Before you shoot tonight, you'll want to see that she's clearly rising. She's had a nice long run in the greens today which is fantastic. My hunch is that she may bounce a bit since these aren't her usual numbers, so she may very well be ready for her PM shot a little early.

Of course now that I've said that she'll give you another low blue.

 

Of course she will, the little stinker! We'll try her regular time (which today is +11) and see what happens. At this point, what's another couple of sticks and minnows?

Edit: She decided to take it easy on us, testing 276 at regular PMPS time, which today is +11 from AM dose.

Djamila: This PMPS, b/c both high and early, suggests that she could have taken 1.0 this morning, correct?

 

I'd say since it was basically an hour earlier, and who knows how much she would have risen for a true +12, yes she probably could have handled 1 unit today. I'd probably still want to be home to keep an eye on her mid cycle if you could, but with that PMPS, she most likely would have been okay.

 

Yeah, there's pretty much no way I could have had the guts to have shot 1.0 this AM Shooting on a 113 was a big step! I did steer her a bit at +4, but not much more than she would likely have steered herself as her timer with a can of LC FF is set to open at +5/+6 (this is the two-compartment, Pet Safe dial kind, so not sure how accurate it is vs. our digital Pet Safe 5, which is just too darn big!).

Still, definitely better to have been able to stay home to monitor her! (Plus I would have been useless at work.)

 

Well shoot. I was kind of hoping she'd surprise us and stay low. She may run high tonight, so at least her ears (and you) will likely get a break this evening. Great job today!

 

Oh, and I agree with Rachel - I wouldn't try the 1u unless you're around to monitor and make sure she's going to surf. My hunch is that even at 1u you would have seen that rise for PMPS. She's just not used to hanging out in the greens like that yet, so her body is going to overreact a bit until those become a regular thing. The higher dose might have helped, but I think at this point it was kind of unavoidable.

 

Me too! I remember the first time she hit the double digits, and you wrote that we’d get “greedy for the greens,” and I thought there’s no way, and yet here we are, disappointed the PMPS isn’t a low blue lol.

Unrelatedly, I noticed that Sam eats Primal Raw. We got a sampler/starter pack and both Josie and Cody ( civvie) got a quarter of a nugget tonight with regular dinner. Cody ignored his, but Josie ate hers and then a few minutes later moved from her still 1/2 full bowl to lick her already-empty PR bowl, just to be sure it was really and truly empty. (Which is why we think she later snuck back and ate Cody’s too: his PR bowl ended up licked clean as well. He wouldn’t have done that, I don’t think.) She clearly loved it! We might be interested in transitioning her to PR either completely or mostly but are not sure now is a good time for that. So many variables already. What do you think?

 

I am a huge fan of raw food for cats. Sam actually doesn't eat much Primal anymore. Maybe just once/week or so. It's a good product and a conscientious company (they recall when they need to and openly share nutrition info), but he's moved onto a few other foods now. He gets bored easily. His current fav is Vital Essentials Raw patties (rabbit) and homemade raw (chicken or beef) using FoodFurLife supplements. It's super easy to make and since I've started feeding him homemade raw I cannot get over how soft his fur is and how sleek he looks. He's still not quite as skinny as he should be, but he's close.

One of the other benefits of homemade raw is that I don't ground it as much as commercial raw, so he is gnawing on small chunks of meat. Having to chew like that on real proteins is what cleans their teeth, so that is an added benefit. Sam has bad teeth, so anything helps!

My other cat has been eating Rad Cat for years, and won't eat anything else unless he's forced to (the rare occasion I run out and haven't thawed a new batch in time for dinner).

As for the variables, if Josie wants it, I'd say go for it. Don't let her go crazy the first few days though, because if the food change upsets her tummy she might refuse it in the future. But going to a raw food should only improve her numbers if it impacts them at all.

 

I'd have to do some thinking about making my own! I'm happy in the kitchen, and I'm not vegetarian, but I *never* prepare flesh myself b/c it just grosses me out. lol

I wonder about water? We always give them full water bowls, but since we became a No Dry Food household, they don't drink it. Obviously it's not a problem to keep their bowls filled with fresh water, but one of the ways I know that Josie's feeling punky is if she actually troubles herself to drink. Should we expect a change in water intake?

 

You're feeding wet food now? Do you add water to it? When I started on raw food, my cats water intake didn't change any, but I have always added water to their wet food to make it kind of soupy anyway...and I still do that with raw food. So I know my cats get a lot of water intake anwyay.

I was pretty grossed out at the idea of preparing raw food at home, too, but honestly, I've pretty much lost that gross out factor now. We've been doing it for quite awhile now and eventually I just got used to it I guess. I can now clean out my meat grinder and barely notice what I'm doing...and I used to be a person who only wore gloves when handling any raw meat at all!

 

Oh, it totally grosses me out. And I do wear gloves. I started doing it when Sam was really sick and I would have done just about anything to help him feel better. I've kept doing it because I see the health benefits to him, and because it's so cheap. High quality foods are expensive, and Sam is expensive enough with all of his diabetes stuff and vet visits. Making some of his food saves a ton of money every month. The Vital Essential patties that he likes work out to about $1.60/each. A serving of homemade varies by meat (and grocery store sales), but is less than 40 cents. That adds up over the course of a year!

I keep water out for the kitties, but they hardly ever touch it. Most of the time, it just gets tossed into a plant and refilled with no evidence that either kitty has touched it. Once in awhile on a hot day I'll see one of them take a drink.

 

Wait! Grinders? There are kitchen appliances needed for this?!

They do get all canned food although we don't add water to it. (They do like to lap things up, and I think sometimes the pate gets stuck in Josie's cheeks, so maybe we should start doing that for reasons in addition to the added water content . . . )

Djamila: I went to the Fur For Life website, and I admit it made my head hurt a little bit. Too much information all at once. (Or too little coffee, one or the other.) Skin, no skin, fat cat, skinny cat . . . what if I have one of each? I'll have to go back to it again . . .

Rachel: Do you use Fur For Life, or just do your own recipe?

 

Oops...shouldn't have mentioned the appliances yet. Don't want to scare you off too soon!

I use Dr. Pierson's recipe at https://catinfo.org/making-cat-food/. It's not that hard...just grind up the meat, add the supplements, mix it up and freeze it. I've heard great things about FoodFurLife but I had decided to do Dr. Pierson's recipe before I knew about FoodFurLife so I just stuck with it from then on. It's been great...my cats eat less now than they used to, don't act starved all the time, and are healthier. I do a huge amount at once and freeze it all until I run out and then start again! The clean up takes the longest probably...I lysol my kitchen and then use a sanitizer all over it. No chance of raw meat sitting around here!

I'd suggest taking the info in small sips. I took a long time of studying before I decided to do it myself.

Let Djamila and me know if you have any questions. Between us we can answer about FoodFurLife, Dr. Pierson's recipe, and all sorts of info about raw food.

 

There is a lot of info there, for sure. And you may also want to look into catinfo.or.....nevermind....Rachel's post just showed up.

It did take a little experimenting to figure out the best "recipe" for Sam, but this is how I do it: I buy chicken breast from the grocery when it's on sale (he doesn't like thighs ). I start cutting the breast into rough, large-ish chunks and weigh out a few 1.5oz portions. Then I toss those into the food processor/blender that I have, measure the FoodFurLife powder and toss in, measure the amount of water that Sam likes best (about 1.5T per 1.5oz of meat). Then I pulse the blender until it's the consistency he likes. He likes it about like ground beef - not too smooth, not too chunky. Then I scoop it into an ice cube tray, freeze, and put it into a ziplock. He also really loves beef. Too much beef isn't good for them though, so he gets that less frequently. He also likes turkey, but I haven't found that in a way that is affordable except at Thanksgiving time.

So now the short version:
1. weigh meat
2. measure powder and water
3. pulse the blender
4. freeze

It took a few batches to figure out what he likes. On the earlier batches, I would just do one portion of 1.5oz. Then once I figured him out, I can make a week's worth in about ten minutes (including rinsing the blender/cutting board and putting in dishwasher).

 

Is 1.5 oz. a magical amount b/c that's what you feed him at a time?

 

That's about a quarter of the mid sized cans of cat food and a good amount for a small meal when you feed several times a day.

 

Perfect -- thanks!