? Would a lower dose be more effective?

I had written about Chino's insulin dose in this thread (http://www.felinediabetes.com/FDMB/...-role-in-the-tr-protocol.170605/#post-1859519) and Nan raised the possibility that he was started on too high of a dose. Is there a protocol for decreasing the dose to determine if a lower dose would be more effective? He currently spends most of his time in the 300s and 400s.

The background:

• He was originally prescribed 1 unit twice daily. BG was 422 (per AT2) and the vet told me not to test until 7 days out.
• 7 days later, his AMPS was 429, +2 was 524 (per AT2). The vet increased the dose to 2 units twice daily and again advised not to test until 7 days later.
• I moved to a new city before the week was up and found a new vet. The dose was increased to 2.5 units.
• After taking him to the emergency clinic with +2 BG above 600 (no ketones), the dose was increased to 3 units (emergency vet advised increasing to 3 or 3.5).

Thanks,
Adrian

 

Looking at 12/17 and 12/20, he had 2 nadirs in the 200s when he was on 2 units. They've all been in the 300s and 400s since he went up to 2.5, except for the 12/29 PM nadir (after an AM fur shot). Would you back down to 2? If so, how gradually? In increments of 0.5 or 0.25?

 

I'll tag a few people but it might take a while for a response.

@Marje and Gracie
@Wendy&Neko
@Sienne and Gabby (GA)
@julie & punkin (ga)

 

Hi Adrian - I do NOT think this spreadsheet looks like a cat on too much insulin. You are doing a great job testing and I don't think you are missing any low numbers. In fact, you could follow TR if you wanted and he is eating just low carb wet or raw. Remember that although yellow may look good when all you are seeing is red or pink, the goal is green. The blue you've been seeing on this dose is a good sign.

Are you testing Chino for ketones regularly? I would do so as long as he's seeing a lot of high numbers. How is he acting otherwise? Appetite OK? Playful? Litter box seeing the expected results?

We determine the dose based on how low it takes the cat. Since you are following SLGS, you would continue to hold this dose as SLGS says to hold the dose if you are seeing some nadirs below 150. Hold the dose for a week, do a curve, then re-evaluate the dose. Any increases (or decreases) on SLGS are by 0.25 units at a time. And yes, your vets did increase the dose by too much at once. But that may have been OK in his case.

 

Thank you for looking it over. It just bothers me that his blood sugar was lower on a lower dose of insulin. The Relion meter is giving me numbers on 3 units that the AlphaTrak was giving me on 2.5 units.

As for ketones, I've been sitting here watching him for the last 5 hours, waiting for him to pee so I can test, LOL. I don't check as often as I should, but I'm convinced that he waits for me to step out to check the mail or go to the grocery store, and then he takes that opportunity to use the litterbox.

His appetite hasn't changed. He whines while I prepare his food and purrs while he eats it. He has never been very playful as an adult but he does interact with my other cat (they groom each other) and he frequently comes up to me for attention. Stool a little softer than usual, but this is the last day of a course of antibiotics, and I'll resume the probiotics tomorrow morning.

 

Some of the high numbers look like a bounce to me. Bounces occur when numbers drop low but also if there's a large drop (e.g., a couple of hundred points) or into numbers that your' cat isn't used to spending time in. It can often take 3 days/6 cycles for a bounce to clear so the bounce could be clearing out soon.

Wendy has given you the instructions for when to raise Chino's dose when using SLGS. With TR, you are able to raise the dose sooner.

Also, one reminder -- if you are getting a test at +2, ithere's a good chance that the numbers are influenced by food. Even with a very low carb food, numbers will rise after a kitty has eaten.

 

Good point, Sienne. I'm used to seeing a lower number for the evening +2, but I don't often do a morning +2. Though I see now that previous AM +2's were higher than the pre-shot as well.

 

Why did you start using probiotics? On a vets recommendation? Bronx has been using probiotics too but it seems to be controversial if there are any pancreatitis signs (which Bronx has), based on an old study that has been disputed. What are you using and how much?

 

When I had switched Chino and Fox from regular dry food to low-carb dry food, both developed loose/liquid stools, which persisted until almost a week after I switched them to wet food. I purchased the probiotic supplement to help with that, though it arrived a day or two after it started to normalize. I started mixing it with their morning meal anyway since the little one had soft/unformed stools even before the food was changed, and it has definitely helped. (He's a DLH and I was giving him a butt-haircut every other week >_<.) It's PetUltimates Probiotics For Cats. I went with that one because it had a lot of good reviews on Amazon. It came with a scoop to measure the dose. Chino gets a full dose and Fox gets a little less than that (not as much food to mix it with).

 

Just an FYI -- It's not surprising that a kitty will have digestive issues if you switch food, especially from dry to canned, all at once. For many cats, a transition is helpful so you don't end up with bowel issues.

@Bronx's dad - Could you send me the link to the paper you were referring to. I'm curious. Probiotics have become so popular and we have routinely suggested them is a cat is having bowel issues.

 

@Sienne and Gabby (GA)
Here is the orig link I was sent from this board that has great info about feline pancreatitis:
http://www.felinecrf.org/pancreatitis.htm#probiotics
here is the 2008 study that the above link refers to about the caution of probiotics:
www.felinecrf.org/pancreatitis.htm#probiotics
here is a link from a 2014 study that somewhat disputes that 2008 study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056604/

I am still giving Bronx probiotics after all this reading. Same one Adrian is using from Amazon.

 

I haven't met you yet and wanted to stop by and say hi. Welcome to you and Chino.

Here is a thread that can help you find your way back to information on this group, plus some other helpful links: "Where Can I Find?" In the lower half of the first post under "my cat may be ill" there is a section on digestive problems. One of those is a link to a feline IBD group that is specifically about using probiotics with them. My cats aren't diabetic, but I do have one who was vomiting daily in spite of being short-haired. He's now on Renew Ultimate Probiotics (Colon Care) 80,000 CFU and the vomiting has completely stopped. We worked him up to 1 capsule daily for 1 month, then reduced him and now give him 2/3 of a capsule every other day now for maintenance. There is some great info in that link (and the one above it on chronic vomiting) that you might be interested in.

People probiotics seem to be fine and you can give them while giving antibiotics - just separate them by a few hours or it will negate the benefit of the probiotic. It can help prevent diarrhea by giving a probiotic while a cat is on ABs.

By the way, I didn't get a notification of the tag. Sometimes when there are several in a row, the tags don't seem to work. @Doodles & Karen I have no idea why, but I mentioned it to Robert probably more than a year ago and it's still a problem. Maybe try putting a word inbetween, like "and." Fortunately others got the tag and responded. I would also hold the dose where it is and see what shakes out after a little longer. He did get to 111 on the 3u on the night of the 29th - which would make me hold a bit longer and see if he can do it again.

 

Thanks @julie & punkin (ga) note taken

 

Thanks. I'm not used to the ups and downs yet and not sure what's "normal" for a cat that isn't regulated yet. It's hard to be patient when I feel how bony he's gotten and see him camping out by his water bowl all day To all who responded and kept me from jumping the gun and upping his dose too soon, thank you!

 

I think Wendy did a great job of explaining why it appears the dose is not too much. You are doing a great job of testing.

Hang in there. Our kitties don't become Diabetic overnight so it takes some time to see some results.