Ramirez Dosing 2/18

Thank you for the new thread.

So any ideas on why Ram was in the yellow BG zone on 2/18?
Anything different?
 
Deb & Wink said:
So any ideas on why Ram was in the yellow BG zone on 2/18?
Anything different?
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No clue. I did feed him 1/6 a can (2.8 oz can) of his LC food at +1 the night before, I was worried he might drop too fast again and I needed to get sleep so I wanted to catch it early. I double-checked the food chart and saw that the fussie cat tuna & salmon is actually listed as 0 carb, so not sure how much of an effect that would have anyway. It definitely didn't seem to hurt, so I might try that again tonight.
 
@Deb & Wink @Shelley & Jess i was wondering if it wouldn't be time for a dose increase, Ramirez was doing very well on 4 units but then the dose was decreased by 1 unit to 3 which seems to me a big drop. For the last cycles he is in red and pink. On the 21/2 he seems to be lowering to yellow, which might mean a bounce clearance but he is still not going any lower. It is only my opinion that it is a pity to lose that momentum from the beginning of February

@Chin do you have the possibility to increase by 0.25 to make it more gradual?
 
With the U40 syringes, some of them have 1/2 unit markings on the barrel. Some do not. There are no insulin syringes with 1/4 unit markings on the barrel.
So you use your best judgement to "eyeball" the dose and be consistent from shot to shot.

This sticky has some pictures of U100 syringes, showing the plunger placement for those in-between doses. The concept is the same for U40 syringes, on placing the plunger between the lines.
Sticky INSULIN CARE AND SYRINGE INFO Proper Handling and Drawing
 
I wanted to add that the black and red pre-shot tests usually indicate your cat dropped lower at some point in the cycle, and they are "bouncing" from those lows.
You need to wait for the bounce to clear AND try to get some more mid-cycle tests to try and catch those low numbers.
 
So Ramirez dropped into the high blue BG range at +4 last night. That's GOOD!
"The greater the drop, the higher the bounce."
So it's very possible that he dropped even lower than that 192 at +4.
Did you get another test later last night? So you know what the gravy food did for his BG levels?

You are going to hate doing this, but testing around +6 or +7 would help too.
I used to set an alarm to wake me up so I could test Wink later at night.

Next time, try only giving Ramirez his regular low carb food as a first choice when he is dropping lower.
Only if that doesn't bring very low numbers back up, then you reach for MC and then HC and then syrup/honey.
Those high blues are not low.
 
Deb & Wink said:
"The greater the drop, the higher the bounce."
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I guess I'm a little confused about this. He dropped more than 50% by +4 and I read that a normal cycle is around 50% at nadir (I do understand that ECID so maybe that's an okay drop for Ram?). If his 192 @ +4 is good, than was the drop not too steep after all? For instance, I was worried he might continue dropping from that 192 @ +4 to ~100 @ +6, which would seem to be a pretty low nadir from his 473 PMPS. Since Ram is bouncing a lot, perhaps I am worrying too much and these swings are relatively normal for him?

Deb & Wink said:
Only if that doesn't bring very low numbers back up, then you reach for MC and then HC and then syrup/honey.
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Thank you for the clarification, I mistakenly used it just to try to slow him down. Last night was a bit of a deviation in my routine, I had a tumultuous evening and I was extremely tired so I couldn't stay up to continue monitoring. It's taking me some time to get used to testing at night and adjusting my sleep schedule but I am prepared to start getting those +6 tests, starting tonight.
 
A normal cycle should not be more than 50% at nadir. 50% is about the MAXIMUM you want to see your cat's BG drop.

A larger drop (close to or more than that 50%) usually leads to a higher bounce.

The drop at +4 was more than you want to see, percentage wise at least. But seeing Ramirez down in the blues was the good part of that +4 drop.
Here are some examples of drops.
400 down to 300 back up to 400 = not as much of a bounce (25% drop)
400 to 200 back up to 400 = more of a bounce (50% drop at nadir)
670 down to 268 back up to 402 = an even bigger bounce (60% drop at nadir, with a 50% rise from nadir to the next preshot)
471 to 337 to 418 = 28% drop at nadir, with a 24% rise to the next preshot
400 down to 200 back up to 500 = an even bigger bounce (50% drop at nadir but a

Try slowing down the big drops by splitting up the food into mini-meals, and feeding both after the insulin shot and closer to +2. Slow the drops before they have too much of a chance to get started. A mini-meal, of a teaspoon of the regular low carb food should be enough. But you'll have to experiment. This is where keeping track of the meals and the + hours fed come in handy, and that information can go right on the SS, over in the Remarks column on the far right. It will let you look back at what you did in the past and try to see some patterns.

Not saying you have to get a +6 every night. But one now and then would be helpful. Especially if Ramirez is lower than you are used to early in the cycle. With his being so high in the AM, I do think you want to get at least of couple of +6 tests in the next few nights.

p.s. Been going through some "tumultuous times" myself the last few days.
 
Thanks for the detailed info! Those examples are giving me a better idea of how to assess what's going on. I'll try the teaspoon of LC food first next time and continue from there.

As for your P.S. - I hope the trouble passes and that all remains well with you and yours. Your guidance has been really helpful and Ram and I really appreciate it!
 
Liz & Minnie said:
haven't seen posts from you last couple of days. Things are looking good for you, nice and yellow!
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Been a little busy and sleep deprived after getting those PM +6 tests in! Thankfully I got a full 8hrs last night and I'm feeling rejuvenated. Indeed, I am very glad to see those 2 lower AMPS's!

Deb & Wink said:
How about increasing the dose to 3.25U?
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I think I will end up doing that, but I'm interested in seeing how he reacts to 3U again tonight (going to try to get another +6 test in), since I'm expecting a lower PMPS than usual. Not sure what's up with his day cycle yesterday, I think I might've messed up the shot and didn't notice - I was pretty sleep deprived when I gave it and the nadir for that cycle looks so out of the norm (except for the day cycle on 2/18 I guess). So, depending on how tonight goes I may increase to 3.25U in the morning.
 
Forgot I had plans today and wasn't available to monitor, so I kept the dose steady at 3. Didn't get that lower PMPS I was expecting last night, but he was lower tonight.

I got home around his dinner time to some brown liquid vomit with some hair in it, but not really enough to be a hairball. I have another cat so, no way to tell for sure, but I suspect it was Ram. In the past 2-3 weeks or so he's vomited some yellow bile in the morning 2 times, also pretty close to his feeding time. Forgot to record those incidents in the remarks cause they were first thing in the morning - also, it seemed somewhat innocuous to me but figured I'd mention it and going to note it from now on. I've been planning on taking him to a new vet for a checkup, but going to make that appointment sooner rather than later now.
 
Glad to hear you will be getting Ram checked out at the vet. That yellow bile vomit needs to be looked into, to find the cause.
 
Darn fur shots!!!!! :(

Have you thought about shaving a small patch on Ram, so it's easier to see where you are shooting, and to make sure you aren't poking the needle out the other side of the tent of skin?

Perhaps have your vet check for Pancreatitis. Snap fPL (if your vet uses Idexx for testing and can do in-house results) gives a Yes/No answer. Then you want the Spec fPL if it's a yes. Antech doesn't offer a Snap FPL, but they have another test to check, but it has to be sent out overnight for the results. PrecisionPSL.
 
I haven't had much of an issue w/ fur shots overall so I don't think its necessary, but if it continues to be a problem I'll definitely consider it. The vet said he's dehydrated, he's been having dark stool too and signs of constipation. Not sure how that simple cause slipped my mind... They gave him fluids and I'm going to take him in again for more in a couple days. I feed him dehydrated minnows as treats and think that's probably contributing to it, so I'm going to stop that immediately. Vet says he thinks it's a one-off so hopefully he improves after I cut those out of the diet and he gets some infusions.
 
So Ram's PMPS last night was 78, I did another test to confirm and it was 86. I was already about 20 min late to his regular feeding time so I didn't think he would have much of a rise if I stalled, but I realize now that I should have done that anyway. I was also pretty confused because I haven't read anything about a pre-shot test being lower than the nadir of the last cycle. I took him to the vet around +6 in his cycle and the vet said he tested 186. The obvious difference with that cycle was that he was given subcutaneous fluids and, I forgot to mention earlier, some antibiotics for his GI tract (1ml ClindaCure twice daily). I'm wondering if one of those may have caused him to go lower and, more generally, if there is anything else I should know about dealing with a pre-shot that's lower than the nadir of the last cycle?
 
Ramirez earned himself a dose reduction, by dropping <90 mg/dL. Doesn't matter that the low came at pre-shot test time. ANY time during the 12 hour cycle, when you are using the SLGS dosing method, counts for that dose reduction.
Chin said:
I'm wondering if one of those may have caused him to go lower and, more generally, if there is anything else I should know about dealing with a pre-shot that's lower than the nadir of the last cycle?
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Sometimes, simply the visit to the vet can throw the BG levels off from normal. Cat might not be eating like they normally would, at the usual times or eating the usual amounts, is one reason for those BG's to be "Off".

If the sub-q fluids and the insulin were given in the same area of the body, that can interfere with the insulin dose. More of an issue for depot type insulins though, not Prozinc usually. I have no idea if the antibiotics would have made a difference, but I doubt it.

If your pre-shot is lower than you are used to, remember you can stall for up to 1 hour without feeding and still stick to your normal dosing schedule for the next cycle.

Instead of skipping the dose, you could do a reduced dose. We sometimes call that a BCS (big chicken shot).
 
Ram tested 61 at +2 so I've had a long night steering and monitoring - details in the remarks column. Lmk if you think a reduction to 2.75U is appropriate, otherwise I'll keep it steady at 3U for a few cycles and see how he does. Thanks!
 
Yes, he's DEFINITELY ready for a dose reduction.
You did a good job of monitoring and steering the cycle with food.

Hope you see this reply before you give Ram his PM dose for 3/4/21.
Please reduce to 2.75U for the foreseeable future.

He's bouncing from those lows last night. So don't let the high pre-shots fool you into thinking you should give him the old 3U dose.
 
Chin said:
He hit 82 last night at +4, despite the fact I anticipated it and fed him some LC at +1 and +2. No bounce this AM, which kinda surprised me. Reduced the dose again to 2.5U
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Very nice to see Ram react so nicely to insulin :):) great progress, congratulations :)

i don't know how it works with SLGS and with Prozinc insulin but what we are trying to do with Chico is keep him longer on a good dose for him to have time to to get used to low numbers and stop bouncing - just maybe something to consider. He did go under 90, which i understand is the value for decreasing the dose with SLGS so great job :)

Good luck further on :)
 
Chin another though that i thought was worth sharing is to measure ketones in the process of insulin reduction. I understand we should measure when they have high BG and when we decrease insulin dosage, because ketones form when the body doesn’t receive enough insulin.
We found it easiest to measure right after Chico pees directly from the littler box but there are other ways too, you can read here
 
Thanks for the support everyone. Haven't tested for ketones yet, I'll see if I can catch him peeing tomorrow after cleaning the litter box and doing a control test w/ water.
 
Amazing progress Chin, Ram didn't have any red for 5.5 days, that's an amazing milestone:cat::cat::cat:

i believe you might have rushed with the dose decrease though, if you follow SLGS you decrease the dose when nadir is below 90, yesterday he was very close with a 93 but i believe it is not quite there yet. Let's see what @Deb & Wink thinks, since i am not qualified to be giving any dosing advice

So nice to see that his pancreas is healing :cat::cat:
 
Thank you! I'm feeling very good about his progress and his improvement in symptoms! He's not bugging me for food as much, reverting to more of his normal behavior like sleeping on my jacket instead of by the food dishes and grooming himself more. His coat looked and felt great this morning. He was also drooling a bit this morning which is trademark Ramirez behavior - before diagnosis whenever he wanted to cuddle, you knew that in a few minutes you were gonna be trying to dodge large tendrils of drool from drenching your clothes :p:D

As for the dosage, I decided to err on the side of decreasing it. My reasoning is that he was within the margin of error of being below 90, that it was a lower day-cycle nadir than usual, that he sometimes hits the nadir a bit earlier around +5, and finally that I am increasing the amount of water I add to his food. I really think that his dehydration was interfering with the absorption of the insulin, since I've been able to reduce the dose quite drastically in such a short amount of time while increasing his water intake. I'm happy to see today's AMPS of 201, though I'm trying to stay aware that his numbers may be a bit skewed since I'm shooting on a +11/+13 schedule pretty often now. We'll see how he does on 2U today and I'm gonna try to get another curve in over the weekend to understand his cycle better. I am certainly feeling very optimistic about all of this! :joyful:
 
Chin said:
Thank you! I'm feeling very good about his progress and his improvement in symptoms! He's not bugging me for food as much, reverting to more of his normal behavior like sleeping on my jacket instead of by the food dishes and grooming himself more. His coat looked and felt great this morning. He was also drooling a bit this morning which is trademark Ramirez behavior - before diagnosis whenever he wanted to cuddle, you knew that in a few minutes you were gonna be trying to dodge large tendrils of drool from drenching your clothes :p:D

As for the dosage, I decided to err on the side of decreasing it. My reasoning is that he was within the margin of error of being below 90, that it was a lower day-cycle nadir than usual, that he sometimes hits the nadir a bit earlier around +5, and finally that I am increasing the amount of water I add to his food. I really think that his dehydration was interfering with the absorption of the insulin, since I've been able to reduce the dose quite drastically in such a short amount of time while increasing his water intake. I'm happy to see today's AMPS of 201, though I'm trying to stay aware that his numbers may be a bit skewed since I'm shooting on a +11/+13 schedule pretty often now. We'll see how he does on 2U today and I'm gonna try to get another curve in over the weekend to understand his cycle better. I am certainly feeling very optimistic about all of this! :joyful:
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I’m so happy to find out he is doing so much better, that must be a great reward for all the hard work you put into this :)

great idea of ading water to his food, we do that as well and feel much better about Chico’s hydration

keep up the great work and i’m crossing my fingers for Ram’s continuous imprivement:cat::cat:
 
Chin said:
As for the dosage, I decided to err on the side of decreasing it. My reasoning is that he was within the margin of error of being below 90, that it was a lower day-cycle nadir than usual, that he sometimes hits the nadir a bit earlier around +5,
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I would have done the same, a dose decrease.

I'm not a huge stickler for hitting those dose reduction points, like dropping <90 mg/dL for a dose reduction with SLGS. Some people are sticklers, but YOU know your cat better than we ever will. The guidelines are simply that. You adjust based on how well you know YOUR cat and what is going on with them.

We focus on the BG levels a lot here, because we can't see those behavior changes. But more grooming and the dreaded drooling are both saying to me that Ramirez is doing better. Sounds like you need a bib, to catch the drool, just like a new mom or dad with a human baby would need.
 
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