Yoyo's BG Going High

I am getting very frustrated with Levemir. With Lantus, even though readings were all over the place, his quality of life appeared much better.

Yoyo has allergy problems. He is severely flea allergic. I am now applying flea treatment weekly and he has been flea free for the past month. I have gotten lax with his chlorpheniramine 2xday since his fleas have been under control and he has started scratching and pulling out tufts of hair again. After I saw he was pulling out tufts of hair 2 days ago, I have been giving him his 2xday pills and check floor to be sure I don't find them around the house. He HATES those pills and they are hard to get down him. I am hoping that the allergy problem is what is sending his BG's sky high....

I think I have an SS now and if any comments will be much appreciated.

Thanks,
Lana

 

Lana, I can understand your frustration. Especially too with his scratching and itching. Have your tried giving him a raw diet? Maybe it is more than just the flea allergy. Many people like Nature's Variety frozen medallions. What brand of Fancy Feast are you giving him?

Does he always eat the same amount of food everyday? Could it be that he went lower on that .5 unit because he didn't get enough to eat those two days?

Did he by any chance get into the dry food that you feed your other cat and that is why he went so high yesterday? Even a few pieces of kibble will send Tigger's bg's higher.

I understand the chlorpheniramine is very bitter tasting. I am sure it is very hard giving it to him. I read that it comes in a transdermal gel. Maybe that would be easier. Have you been in to see the new vet yet?

 

In Yoyo's 15 years, he has had many skin problems. One vet told me that white cats have a lot of skin problems so I have come view Yoyo as having "White Cat Syndrome." So, yes. He could have food allergies in addition to the flea allergy. I feed Yoyo low carb Fancy Feast from Janet & Binky's List. Yoyo is a chow hound. Before diabetes I gave him lots of Fancy Feast gravy varieties and when I switched to non-gravy varieties, I thought the cat was going to die. He literally refused to eat. When cats go into "starvation mode," they begin to cannibalize their own organs for protein just as humans convert their fat to sugar for energy. He got very sick. I will pick up some Nature's Variety frozen medallions and see if I can add some little by little. If he has to tear these medallions, it may not work for him. He is 15 years old, has a tooth missing --- might be a problem for him.

The amount of food Yoyo eats varies. The closer to normal his BG becomes, the less he eats and the more he tends to snack through the day. When he is very diabetic, he tends to be voracious and inhale everything at once. I find it is better to let him eat what he needs - knowing that the quantity will not be very much as his blood sugar gets adequately managed. Months ago, when he was so voracious and eating massive amounts of food, the vet told me not to let him have it. He started spraying in the house -- something he has never done in his life -- and never done since -- I decided if he was that miserable and desperate, then feed him as much as he wants. As I got his BG under control, the quantity he ate dropped dramatically on its own. I haven't noticed Yoyo's BG fluctuating based on what he eats, but then again, I've never seen much rhyme or reason to any of his BG results. Although on Lantus, I was able to determine that his BG's over 400 occurred when he got a flea. I figured that out because once I actually got rid of the fleas, I stopped seeing BG's over 400.

I have not gone to a new vet yet. I am so pleased to have several recommendations. I have checked their websites and know that I have a resource among them who takes walk-ins so that has taken a huge amount of stress off of me should I have an emergency.

It is good to know about the transdermal gel.

Thanks,
Lana

Fancy Feast Varieties: Flaked, Roasted, Chopped Grill, Tender (Beef, Beef & liver, etc), Turkey & Giblets, Ocean Whitefish, Cod Sole & Shrimp, Savory Salmon --Mostly 0 to 5% carb with a few 6 - 10% for variety. I put out EVO dry 2/3 mixed with 1/3 regular dry for my other cat. Yoyo does eat small amounts of it from time to time but he is primarily a wet food cat and I have not not noticed a BG fluctuation caused by the small amt of dry he eats. My other cat is primarily a dry food cat.

 

Tigger has a front fang missing too. He is also fifteen. The raw food I get is already pretty soupy. Maybe you could mash up the frozen medallions as they thaw?

I am not an expert on cat foods that cause allergies. But I understand that there are a lot of ingredients in canned cat food that can cause these allergies, wheat gluten is a big culprit. Here is a list of gluten free varieties that has been compiled on this forum. You have listed the Fancy Feast varieties you are feeding, but I wonder are they the Classic varieties?

http://www.felinediabetes.com/glutenfree.htm

Also, I forgot to mention that I read about adding Omega 3 oil to the chlorpheniramine (Clor-trimeton) which might also help:

"In the treatment of allergic skin disease, antihistamines are felt to synergize with omega 3 fatty acid supplements and, as a general rule for this condition, it is best to use these medications together."

http://www.marvistavet.com/html/body_clor-trimeton.html

Hopefully though, a change in diet might help too.

As far as the dose, you should change the dose according to the nadir. If this were Tigger, I would probably raise the dose to 1.25 and see how he does. Here, according to the Tilly protocol:

viewtopic.php?f=9&t=1581

"General" Guidelines:

* Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).

* Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).

* Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose...

* Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.

* After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

* After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit."

I hope this helps somewhat. Please come back and ask questions. Please don't give up on the levemir yet. It is a really good insulin.

 

Lana, what was his starting dose on lantus? I am wondering if he actually needs a dose decrease not a dose increase. My reasoning is that his 400s and the 500 are on 1u and higher. He hasn't had any lower, green numbers since he was at .5u. Seeing a swing of about 400 points (from 158 to 543) is more typical of rebound than of not enough insulin.

I second the idea that the skin issues may be from food allergies. It is worth looking into. FYI, Wellness canned (in the large 13 oz can) is about the same price as Fancy Feast and it has no grains or fillers in it. The turkey, chicken or duck flavors might be worth trying for a week or so to see if there is any difference. (although they just recalled their canned food for not having enough thiamine in it. Hopefully, it wil be back on the market very soon). I would stay away from beef and fish flavors of FF. Many cats are sensitive to beef and fish isn't good too often. I feed it 2-4 times a week out of 21 meals/week. The Gourmet Chicken is probably the best of the FF for a cat that may have allergies to foods. I think the flaked and chopped grill ones have wheat gluten in them and he could be sensitive to that.

 

Hi Lana,
Yoyo's spreadsheet looks like a classic case where doses are given as reactions to preshot levels, rather than looking at nadirs and whole cycles. Levemir can be tricky because a dose given 3 cycles before can affect your preshot today. A perfect example is 3/4 through 3/6.

On the AM of 3/4 he got a furshot. So no insulin that day but the numbers weren't too bad because the previous night's dose and previous shed had an affect. You stayed with .75U dose and numbers remained in the 300s for the next 3 cycles then wham-o he gets to 400 by the 4th cycle because the shed has been run dry since it started being depleting when the fur shot happened. Because that one cycle's shot is missing, the Levemir could not keep up over the course of those cycles and he threw a 400 as a result of a missed shot 4 cycles before.

Does that make sense? It is critical to understand this about Levemir, because you cannot react to preshots by raising the dose as you did on that 400 since it was not caused by the wrong dose. It was caused by not enough insulin to maintain the shed over the course of the 3 days due to the missed shot.

From the overall look of the SS, I agree with Sheila that the dose needs lowered, but what I see over that period for the first week of March makes me think .75U might be a good dose for him as 3/4 should have turned in to a perfect cycle, had he not received a furshot! He held on to decent numbers without insulin for a couple hours on his own, meaning had he received his shot, he would have seen a slight increase, but then probably leveled out and you might have had an even lower preshot that evening.

Of course that's all water under the bridge. If you're wondering why he's had green numbers on higher doses, the shed is your answer. He built up the shed quicker on the 1.125U dose which resulted in the greens, but then dose was dropped to .5U and the shed was lost within 3 days. Classic pattern.

It's important with some cats to hold doses longer than 3 days or even 5 days. Yoyo is probably one of those. I hope this explanation gave you some incite to how Levemir works and ammunition to help you get him to more level numbers, which is what you're looking for first, rather than greens or even blues, to determine if the dose is good.

 

Raw Food: I picked up a bag of Nature's Variety Frozen Medallions and a small free sample of RAD Cat. I gave Yoyo the RAD Cat as reward for glucose test and he ate it with enthusiasm. I gave him a medallion for dinner tonight. He ate the whole thing before he ate anything else on the plate. I also picked up some Wellness as well as some Merrick and Precise Pet, all without gluten. I have been giving him a lot of fish for variety. I will back off from that and replace it with the Wellness chicken, turkey, etc. I use the Fancy Feast Classics but I also was giving the chunky and roasted varieties which do contain gluten. I will stop the chunky and roasted and see if he improves.

Allergy treatment: I am not sure what "use these medications together" means regarding chlorpheniramine and Omega-3. I give him a pill about 8 am and 9 pm. I mix omega-3 with his afternoon snack. Does it mean use both -- or dose at same time?

Lantus: Yoyo was started on Lantus back in May of last year. If his BG was 200+, I gave 2 units. BG 120 - 200, I gave 1.5 units. BG < 120, no shot. I switched to Levemir Feb 12, starting at 1 unit. All the Levemir data is in the SS.

Glucose Fluctuations: I have to admit, I do not like to see the 400's. Also, I get incredibly nervous when I see a BG drop of 200 or 250 points during a day. If BG dropped from 400 to 150 in one day, then what will happen if BG is 91? I did have pre-shot 91 and injected 1u -- but my heart was in my throat and wondered if I was murdering my cat. I think the main cause of the 543 was the allergy problems -- exacerbated by the missed shot. BGs are settling back down. I knew there had to be a delay before I saw the results of a particular dose. I just couldn't figure out how to explain or predict BG results. I am still lost. Vicky, I think you are right about Yoyo having a longer than normal shed. So... according to recommendations here and the Tilly Protocol, this is what I am understanding:

Goal: BGs within a range of 50 to 200 with 50 to <100 optimal
Raise dose: If nadir >200, raise dose until nadir is in normal range of 50-80. Hold the dose for 3 -5 days if nadirs <200 before increasing.
Lower dose when nadir <100 for a week

So, today, Yoyo started at the day at 353. His lowest number was 102. He finished the day at 343. He drank out of the toilet so I can't estimate the amount of water he drank today. He ate well. But did not act like he felt good at all today. I got his morning pill down him with no problem but I thought I was going to lose a finger with his PM pill. This was Yoyo's 3rd full day at 1 unit and the way I read the protocol, I should stay at 1 unit for 5 full days. I am hoping the way he feels will improve since his numbers are falling.

Thank you, everyone, your suggestions and pointers have been a great help.

Lana

 

I would not change his dose right now is he has a nadir of low 100s and isn't hitting the 400s/500s - some cats tkae longer to fully settle into a dose.

Both lev and lantus work best with consistency. Meaning the same dose every shot, not a different dose for different PS numbers. Of course, if you get a really low PS and don't have data to show it is ok to shoot the full dose on it - don't. Either wait, without feeding, and retest in 30 mins to see if the BG is climbing, or reduce the dose some.

Yesterday, Jeddie was at 68 at PS - very unusual for him. I ended up skipping the shot because I had to leave for several hours and needed to move his shot time earlier by 3 hours anyway. I don't have the data to show I can shoot the full dose on the number anyway, so I would not have don't it without being home all day to test him. On the other hand, Kelley's Oscar was even lower (43) at PS and she shot the full dose because she has data showing he climbs pretty fast from a low like that.

It just takes patience to gather the data and starting low and slowly raising the dose so you know it is safe.

Sounds like he is liking the new food, so paws crossed that it helps his skin issues and he can be more comfortable.

 

Good for Yoyo eating the raw! He knows he is a carnivore. Are you able to get the Rad Cat locally? If so, lucky you. That is a great raw food, but most people don't have local access and have to order it online. The shipping is costly. Glad you changed over the other foods too. It may be a while but it should hopefully help with his skin allergies. Just wondering, does he go outside?

Also, you might want to keep the chunky and roasted foods on hand for your Hypo Tool Box if they are higher carb. Here is a list explaining what this is (not trying to alarm you here - just for your info to be prepared in case):

http://www.felinediabetes.com/phorum5/r ... sg-1661798

I don't really know. I just read that online when I was looking up stuff on the chlorpheniramine. I kind of doubt whether it matters if given at the same time, but do run it by your vet next time you talk to him.

I think you are understanding the protocol pretty well. It really is all about data gathering and then things start to make a little more sense.

As far as shooting a lower preshot, it helps if you can to get a +10 or +11 test in. Then if the preshot number is higher you are generally okay shooting that number since he would be on the rise. Here is a good primer on shooting low numbers - this is just a guideline but it helps explain it pretty well:

viewtopic.php?f=9&t=33860

BTW when you said that he didn't act like he felt well, as I understand the chlorpheniramine it does tend to make them lethargic. Do you think that is what is happening?

 

FyI-The Rabbit raw medallions have cured Buddys allergies completely.
(also, he has had at least 6 or 7 teeth pulled out) so i think going to raw was the right move.
as for the dose, i'll leave that up to the experts here.

 

Data to shoot on low PS: I've collected data for 2hr & 3hrs post injection and Yoyo's BG climbs in that time period. So, does this data show me that I can safely shoot on a low low pre-shot number? For the past few days where I have measured, he has not had any low pre-shot numbers, but the data seems to show me that he is not utilizing newly injected insulin until after 3 hrs.

Rad Cat locally: There is a store about 8 blocks from me that carries Rad Cat and Nature's Variety as well several varieties of canned food. I picked up some samples of dried treats, shrimp & beef, but he showed no interest in them. I noticed that they do carry rabbit. I will pick some up next time and see how he likes it.

Does he go outside: Yes, he has a kitty door. He is very good to come when he is called so I can test his BG, but I have been keeping him inside the past few days because I wanted to keep an eye on his scratching and general behavior, and also, if he weren't regularly at hand, he might not be quite so cooperative for the multiple BG tests I've done for the past 5 days. I've noticed 3 personality types in cats: Wanderers, Conquerors, & Defenders. Yoyo is a Defender. He goes outside in the AM, sprays the garage, sprays the fence in three places, then sprays the house next door where a dog lives. He then goes under the house (my house is pier & beam) and spends a fulfilling day keeping an eye on the driveway just in case some neighbor cat decides to investigate his yard.

FF Roasted & Chunky varieties: Roasted & chunky varieties have a carb percent between 5 and 10. Would they work for a hypo? I have a can of grilled that I purchased by accident which I have kept on the kitchen cabinet for such an occurrence.

Chlorpheniramine Lethargy: Chlorpheniramine does have a sedative effect but he has been taking it since mid-December and I never gotten the impression that it made him feel bad. It seemed mostly to make him drowsy in the beginning, then over time, the effects became pretty minimal so I don't think his lethargy and appearance of feeling bad is connected to the chlorpheniramine.

+10 or +11 BG testing: I did two +10 hr tests -- yesterday and this morning. The numbers have been high. How do I see "viewtopic.php?f=9&t=33860" --- I don't know how to access this information.

Okay..... Yoyo has completed 5 days on 1 unit. His lowest BG for the 5 days was 100, otherwise his BG's have bounced around but tended lower over the course of these 5 days. Today is going to be a high day. He tested 419 2 hrs pre-shot and 567 at PS. I am extremely worried. I know that his BG continues to rise for 2-3 hrs post shot. I will test at +2. I will not be home this afternoon to test for a nadir at 6 hrs so I did not want to change his dose today, but tomorrow I would like to change his dose to 1.125. Does everyone concur that this is appropriate based on his BGs the last 5 days?

Thanks for all your input.

Lana

 

All data that you can get regarding how the insulin is working after the shot and data that you can get at +10 or +11 before the shot is good information to have. I mention below that I will post the primer in another post after this one which explains it pretty well.

That is great. Hopefully the raw food and/or the rabbit will help with his allergies.

That is so funny. I never thought of there being three different personality types for cats that go outdoors. Tigger sounds like the Defender type too. He rarely ventures far from the yard (he only goes out in the daytime) but makes sure he marks it each day to let other critters know that it is his yard.

Those would be what some would described as medium carb foods. Good to have on hand. The grilled varieties would be fine too for a littler higher carb food.

I do not know why some links that I post lately are not showing up correctly. It is something that just started happening. I will post the primer itself in a separate post since it is long.

I would go up to 1.25 at least but that is just me. Those 400's and 500's aren't good. I think sometimes you have to break through the glucose toxcity before you start lowering the dose whether or not he is rebounding. Hopefully others will weigh in but that is what I would do.

BTW you said in your SS that he didn't eat well yesterday morning. Maybe that is why he went down into the blues momentarily. Insulin was on board but without enough food.

 

primer (last post addition)

Okay, adding this primer onto my last post Lana, this is a guideline. You might want to set your no shoot number higher until you have more data, but this explains it quite well:


by Libby and Lucy » Fri Jan 07, 2011 7:56 pm
****The following guidelines apply to those following the Tight Regulation protocol for Lantus and Levemir****

You just tested your cat’s preshot number, and there is a much lower than usual number staring back at you. What do you do?

There is no one-size-fits all answer, but there are some general guidelines. As with everything else, each cat is different (ECID) and each bean is different too.

The short answer is that most kitties can be shot at +12, almost regardless of the number, once you are data ready to do so. The exception is that shooting 30s or 40s is not recommended for most cats, so if the cat is less than 50 then usually the best option is to wait until they are above 50 to shoot. While you’re waiting, the shed is draining, so you want to get the insulin in as soon as it makes sense to shoot.

If it is your first time shooting green, then we will likely suggest that you stall the first time, even if the number is 80-100. That will let you collect data on what your cat will do when you stall. One thing you can do if you are having a low cycle is to get a +10 and +11. Those will give you a good idea of how quickly the cat’s numbers are rising (or not) when preshot time arrives.

Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot.

* If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative.
* If the cat is not a food spiker or tends to have an early onset/early nadir then they may not want to shoot as low. If the cat has a late nadir, then they will HAVE to learn to shoot low.
* We will also be more conservative in some cases because of the person – if you are not able to monitor then you want to be more careful, or if you are not sure that you can get back to the board to keep us updated throughout the cycle. Trust me, if you shoot low, we will be watching for your updates and we will worry if we don’t see them.
* We have to be a lot more careful with the cats who eat only dry food, because they don’t have access to the tools the rest of us use to keep our cats safe.
* Also, when it comes to very low preshots, there is an unwritten rule that whoever helps that person shoot low should expect to sit with them through any low parts of the cycle. There have been times when I knew a cat’s number was likely shootable, but I also knew that I could not be around to help if the shot resulted in low numbers later in the cycle. For safety’s sake, if I could not find someone else who would be available to support for the next several hours, I would most likely suggest that the shot be reduced or skipped. I will not encourage someone to shoot low and then abandon them.
* There are a lot of other scenarios, and you always want to keep your cat in mind.


Some general rules when stalling (ECID):

** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
** 40s or lower – you have a couple of choices.

* When 40’s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
* If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
* --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?


** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.

Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely.

 

Rabbit: I picked up rabbit and I gave Yoyo some this AM. He just ate a little this AM so I don't know if he liked it or not. It is hard to judge the cause of eating a little and walking off, it could just mean this is going to be a snacking day in which he will eat his food over the course of the day --- or that he doesn't like what he was given --- or he's not feeling great. But this was not like Friday when he would not eat his reward and completely refused his meal.

Friday's Refusal to Eat Reducing BG: Don't know if not eating Friday morning led to Yoyo's post shot low numbers, but I will start consistently noting how he eats to see if there is a pattern.

Pill Pockets: I picked up some of these to see if they would work with Yoyo. Last night was fine but this AM, the first one (I broke pill into pieces) got stuck in his throat and he would not touch the rest. Maybe it is for the best. They do contain wheat flour & gluten and I would like to keep him wheat & gluten free for awhile to see if it helps his allergies.

Low Preshot Primer: Thanks for this info. Stalling on the 80-100 in the near term sounds safe to me. I will wait and re-test at those numbers.

With his BGs out of the 400 - 500's, Yoyo is feeling better. He is bouncing around again. I hope the next 5 or so days prove good for him.

Thanks,
lana

 

Looking good today Lana!

What you said on your spreadsheet today...."AM- not interesting in treat after BG test -- heading straight for his dish looking for the the raw stuff."

That just does my heart good! So glad he is taking to the raw. Curious, is that the Rad Cat or the rabbit or the Nature's Variety?

 

I picked up all three. The Nature's Variety comes in the frozen cakes which is very convenient. Easy to take out 3 cakes, let them thaw naturally or microwave for 30 sec. I have a large bag of chicken and a large bag of rabbit. I have been mixing these: 2 cakes of chicken and 1 cake of rabbit. He likes both.

The Rad Cat comes in 8 oz & 16 oz containers. I picked up the 8 oz sizes of chicken and turkey. When I open a Rad Cat container, I feed every meal until it's gone -- about 1/3 of an 8 oz container at each meal. I could probably safely go with the 16 oz container.

So, he loves both Nature's Variety and Rad Cat. Nature's Variety seems to have a chewier texture than Rad Cat but it doesn't seem to faze him.

Yoyo's BG has been leveling out the past two or three days. Wonder if the food changes could have helped with that.

I ordered a magnifying lamp from amazon. It arrived today. I am thrilled. It is great. Well, I haven't exactly used it yet, but I played with an empty syringe and the quality of the magnification was excellent. It has a 5X magnification and the lens is around 3.25" across, pretty big since the rule is: the greater the magnification, the smaller the lens. The arm holding the magnifying lens is flexible. I can bend it upright so I can hold a syringe in a vertical position. The lens head has a built-in light. The magnifier from amazon:

"SE Table Magnifier Lamp - 5X - Fluorescent Light (White)" ----- price: $22.50. Sold by hobbytoolsupply Inc ---has to be this seller. There are some magnifiers sold by other amazon vendors that have the same description but the reviews are full of complaints. The one from hobbytoolsupply is good quality.

Lana

 

Oh, that magnifier light is a great idea! I may look into that myself (no pun intended... well, maybe just a little bit :mrgreen: )

 

I love this. He is taking to the raw so well. Knowing that each cat is different, my Tigger gets 3 ounces of raw morning and night. He weighs 15 pounds and maintains that weight with a good muscle mass.

I do give him small cooked pieces of chicken breasts during the day for a treat, which he loves. Maybe about an ounce twice a day. That way he is always hungry at the next mealtime and usually eats well, or at least finishes his meal within the hour after his shot. Plus I know pretty much how much food he gets on a regular basis in relation to his insulin. Hard to do though for people that have multiple cats.

I hope so, also with his skin allergies.

So this must be the one: The reviews are great! You should add in the reviews that you use it for trying to see microdoses with insulin for your diabetic cat. LOL

http://www.amazon.com/SE-Table-Magnifie ... B000X7AHEY

Let us know how you like it!

As far as Yoyo's numbers, can you get any spot checks in the evening? Even if it is just one before you go to bed it can help a lot to tell what is going on. I am thinking maybe a slight increase is needed here.

 

Yes, that is the one. I added a review this morning. It may be 48 hours until it is posted. I used it for measuring last night and this morning. It is wonderful. It is a stress reducer and I really NEED a stress reducer.

I had such high hopes that Yoyo's BG was moving in the right direction, Down!, but last night and this AM he is back in the 300's. I think you are right that his dose needs to be increased. Vicky had suggested that Yoyo might be one of those cats that needs a longer amount of time at any one dose so I would really like to wait a day or two (if I can---it is so hard not to react to those higher numbers!) before changing his dose.

By "spot checks in the evening" do you mean before his 9 PM PMPS or between 9 PM and when I go to bed? Right now I am running a little low on test strips. I use a Relion Micro meter that works on 3 microns of blood for which Yoyo is very grateful. I order test strips online from Walmart, $20 for a box of 50 strips, and the last order was free shipping. I am waiting on delivery of my recent order of 3 boxes. Getting the test strips through the mail means I only have to go to Walmart for the syringes (Relion, .5 unit markings, $12/box of 100) because they do not sell those online for home delivery.

Lana

 

Oh good, I will check it out! Good for you for adding the review.

I mean between 9PM and before you go to bed. Sometimes this might be only a plus three or a plus four reading, but it helps to see what direction the insulin is going.

I don't use the Relion but I know a lot of people do.

I saw on your spreadsheet that you gave bacon for a treat. Not such a bad idea, but you have to limit it to a very, very small piece because of the sodium and nitrates.

I cook up a chicken breast (microwave in a glass containe or bake in tin foil). That is Tigger's 'treat' after testing. Cut it up and freeze.

 

I wouldn't increase the dose yet - not when you are getting mid-low 100s at PS every other shot. I think he is still settling in the dose, as Vicky suggested.

Try not to react to one (or two) higher numbers, especially at PS. You don't want to raise the dose based on PS numbers. Dose changes should look at the whole cycle and the nadir is very important. Looks like Yoyo's nadir is between +6 and +8.

I also notice that he had very good numbers on .5u back in the end of February. Then he hit a 300 and you started raising the dose. Usually, the 300 after a low of 61 is a bounce and you should not raise the dose because of it. That only leads to rebound - and more bounces. He has been bouncing higher with each dose increase. That may be what caused those 500s last week.

I would actually be inclined to reduce his dose back to .5u and really let that settle and see what happens.

 

Sheila, It gets awfully confusing. It I follow the protocol, I would raise his dose on the next change. Also, according to the protocol, a rebound is caused by an extremely low BG or a precipitous fall in BG. A 61 is a normal BG for a cat, not a low BG. He has had some roller coaster days but I don't know if they qualify as "quick" falls in BG or not. Also, were the green numbers at .5 a result of that dose or a result of building up his shed with the prior 1.125 doses? It leaves my head spinning.

I think that I changed dosages too quickly in the beginning and Vicky may be right that Yoyo needs more than 3 - 5 days to settle into a dose. So let me ask this: I would like to stay at at the current dose of 1.125 for 7 days which will be through tomorrow (Saturday 3/19) then if I drop him back to .75 and keep him at that dose for 7 days, will we know if lowering was effective?

Pamela, I have tried cooking for Yoyo, but he has turned up his nose at everything I've ever prepared for him. I like to give him something for a treat that I do not give him at a meal so he will view it as a something special he gets in return for getting stuck. It gets challenging. He likes change. After getting the same treat for a couple of days, he lets me know that it is not special anymore -- at least not until a few days later, then he is again pleased to get it. I have given him a lot of fishy-type things for treats but I have now cut back on them. I have tried to use the USDA Nutrition Database to look at phosphorus values but I can't get anything that resembles a correspondence to Janet & Binky's Phosphorus values. Oysters & shrimp appear to be lower than fish, so I have been giving him those. I will pick up a chicken breast on my next grocery trip and try again. I can always make chicken salad if he turns up his nose at it.

Lana

 

Or you can give him freeze dried chicken treats. Sheila uses these from Petsmart. I use the Halo Liv-A-Littles from Whole Foods which are a little more expensive.

Will he eat the raw Rad cat without mixing anything else into his mealtime? I am just wondering if we can eliminate one variable such as the food changes. I see that the Precise Mixed Grill has Ground Brown Rice as its fourth ingredient. I see on J&B's charts that it is 8% calories from carbs so not terribly high but higher than the raw probably.

Occasionally I will disagree with Sheila and Vicky but it doesn't mean anything. We are friends! But in this instance I will say I don't think you should lower the dose. I hate to base a possible rebound on just that one day or two. We still don't know if he just didn't eat enough those two days.

But it is up to you. If you lower the dose and he improves then I will be a happy camper either which way. We just want to see him in better numbers.

 

It would please him if I gave him an entire plate of raw. I put out 3 medallions of Nature's Variety or 1/3 of an 8 oz RAD container plus a can of FF or the equivalent of another brand. Yoyo eats all the raw and leaves. The other cat comes along and snacks on some of the canned food left in the plate and Yoyo comes back a couple of hours later and snacks on the canned some more. It may all get eaten over 12 hrs or I may end up tossing leftovers. So nothing would please Yoyo more than an entire plate of raw. However, a bag of chicken & a bag of rabbit -- 48 medallions each and 3 8z containers of RAD Cat was about $48.00. I'll have to do some mathematics on that prospect.

I have found that the premium canned foods have real meat as the first ingredient rather than meat byproducts (whatever they are) but they all have some sort of vegetable product or rice for a binder. I bought some of the ones which were less than 10% carb on Janet & Binky's list to supplement the FF -- since I had stopped using the Roasted varieties (wheat gluten) and the fish flavors.

Thanks for the tip. Is Halo Liv-A-Littles an animal food or human food?

Thank you, Pamela. Lowering the dose seems illogical to me but I decided that, if indeed the dose does need to be lowered, then it is better to lower it from 1.125 units than from 1.25 or 1.5 units. Secondly, I think that, after spending a week at .75 units, we will all be in agreement as to whether to raise, hold, or lower.

Lana

 

A 61 is not "normal" for Yoyo, clearly, so his body is going to react to it.

The easiest way to see if a drop in BG might be a quick fall is to graph the numbers. Do you have a program on your computer to do that? I think it can be done in google docs, but I'm not sure how.

I gather the plan is to stay at 1.125 for a few more cycles? I know you hate seeing him so high, but it's reasonable to get more data at this dose before deciding where to go next. He's had some upsetting issues and the diet change since last he was at this dose, so maintaining dose is one less change to the equation.

I am wondering if it's possible for you to get some PM cycle spot checks once you get more strips? That data can sometimes yield information as PM cycles are not always the same as AM ones. You don't have to get whole curves, just a check around nadir or early or late in the cycle over a few cycles and take a look overall to get an idea how low he's going overnight.

 

Lana, just a quick note.

I wonder why when you quote someone it shows up as a quote from you? I can't figure out how that is happening. It gets confusing though because it looks like you are answering your own question.

The Liv-A-Littles are freeze dried chicken pieces. They also come in other flavors but I have just used the chicken variety. Here is the link. Using the store locator it looks like they have them at Whole Foods and Petco in Houston:

http://shop.halopets.com/Liv-a-Littles-Chicken