Previous https://www.felinediabetes.com/FDMB/threads/4-6-cleo-pmps-201.261224/ @FrostD Thinking of increasing tonight but hesitating...
Hi Angela! Good morning! I am sure Melissa will be around soon. It looks like you haven't held this dose for 7 days yet (14 cycles). Yes, it looks like an increase will be warranted, but can you hold for 7 days (per SLGS protocol). You have seen a blue a couple of times on this dose, albeit higher end blues. You're getting close to completing 14 cycles.
P.S. I love calicos. Mine is called Ginger (and she is spicy, which mostly means vocal and letting you know what she wants... but she's very loving with us!)
Suzanne - I think the signature is outdated, she's only giving low carb wet now? If that's the case yes I would increase again. Unfortunately this SS has been reading a bit like an IAA cat, I've been thinking it but haven't said it, hoping that's not the case. Once she gets to 6U we'd recommend having her tested, but you have a long way to go til 6U yet.
Hi Suzanne Thanks so much for your response and all your responses to countless members here. I enjoy reading them and am learning tons! I already gave morning dose and figured I'd ask for the evening dose. I work away from home from am +2ish to +11ish which makes MPM difficult to follow by it's rules although Cleo is on only wet low carb diet. (I am big on following the rules lol). Melissa has given me wonderful advice and hand holding in upping the dose a little sooner because we're a little concerned about glucose toxicity and duration of insulin which is why increases are sooner than the 7days. Looking to see if the data warrants another nudge (since only seen higher blues) or if I should pick up my patience pants from the cleaners. Thanks so much for all you do!
@FrostD and @Suzanne & Darcy You ladies are quick with the responses!! I only posted this morning to give myself a 12 hour head start. LOL Haha - Cleo is the same! Although she's a little less loving at night recently. She's starting swiping at us while we are sleeping looking for snacks . Thinking a timed feeder is in the future list of purchases, but I was holding off until she was seeing better numbers. Corrected the SS and YES all low carb wet food (and no tummy issues yeah!) I've been thinking about it too but I recall you once said that its still too soon since dx (1/3/22) and starting ProZinc (2/22/22) and dose not yet high enough but if that's the case then so be it. She needs as much insulin as she needs . I thought we had an understanding that you DO NOT need to be gentle with me. (that goes for you too @Suzanne & Darcy ) I'm not that sensitive. Will increase to 3U tonight - wish me luck!
Good luck! It is still early, but usually most cats see more consistent blues as the increases happen. Right now she sees it 1-3 cycles then back up, and you just kind of keep chasing doses - that's kind of how IAA goes. Hopefully just glucose toxicity, but if it is IAA it's not that bad, it usually resolves on its own in about a year (the bigger concern as I'm sure you've also seen in your perusing is acromegaly, we also recommend testing for that at the 6U mark, but her SS doesn't quite read that way at the moment). But like I said far too early to make that call, I've just been thinking about it
Truth be told that I'm not really too concerned if she gets either of those diagnoses b/c of this message board. I know that either are manageable ONLY BECAUSE AND ESPECIALLY WITH ALL YOU guys here. I have you all helping me help her and that takes away soooo much of the fear and anxiety. We've come a long way already. Its crazy to think that up until last month (literally 30 days ago today) I couldn't even get a BG test and now I'm doing it consistently and sometime with my eyes half closed in the middle of the night! This could NEVER have happened without this message board. I hope one day I can help as much as I've been helped...especially emotionally! Ok Ok enough mushy stuff ... back to business! I'm working a 1/2 day tomorrow so I will be home and can test from 4/14 AM+7ish on to see if it takes her too low and I'll do a curve on the 4th cycle at 3Us to evaluate. If I see anything wonky you'll hear from me. That's a threat (JK) and a promise.
Sounds good. I followed TR so never had to wait that long to increase…. Which was good for me because I didn’t have much patience (dry cleaner must’ve lost them!)
Morning @FrostD Cleo's progress on 3 units gave us a decent blue in 2nd cycle and (I think) a bounce in the 3rd. (Or maybe it's not a bounce but HER normal in the 200s) Would you suggest a curve in cycle 4 or would it be better for cycle 5 and give bounce time to clear but not too much time for glucose toxicity to take hold? I'm available to do either one. Thanks!
I do not think that 317 at +2 was a bounce -- probably just food and the insulin hadn't kicked in yet. Cleo went back to yellow after that and then back to pink this morning probably because the ProZinc was wearing/worn off. Cleo is doing so well. You are doing a FANTASTIC job. I wish all the people who join this Board would really engage in this as well, and as much, as you have. It's so frustrating at times. And then we've also had some sad losses recently (really gets me down!) But looking at you and Cleo gets me back "up" again! I'm very happy about how well Cleo is doing with your help.
What is Cleo eating these days? I saw the Dr. Elsey's, but what else? That's the Dr. Elsey's dry, right? Not the canned stuff. Just trying to remember. Forgive me.
And yes, that blue is GREAT to see. I love it! Hopefully some more blue today (and hopefully no bounce or if so -- a very short one!)
@Suzanne & Darcy I adore you!!! And your encouraging words!!! You are too kind in your adjectives (blushing). I am so saddened by the recent losses. So Cleo is 100% low carb WET Ziwi peak pates. The Dr Elsey's is DRY and ONLY used as a special treat or when no one is home. We put less than 1/8 cup in a food puzzle for her. I am still fairly new at this and deciphering between a bounce vs glucose toxicity is going to take more time and lurking at SS haha. I do feel that the more I understand the more I relax and then she does. She's always been a "spicy" kitty who only wanted to be touched when she wants it and even then it was a 3 pet maximum before she would hiss and swipe The first 6weeks after dx I could barely function. I'm thinking of doing a curve just not sure if I should do it this cycle or next or wait until the 6? She tends to rise quickly into yellows and staying there after a couple of decent blues.
Hmm. She seems to give blue the first 3 cycles and then not again. She's a bit high this morning so I don't think you'll see much with a curve, but it's really up to you!
Thanks Melissa. I will give her pin cushion ears a break but still will get a +3, +6, and +9 per protocol.
Excellent. When I checked on her earlier today (at the nail salon having mani/pedi with my daughter) she was still yellow. Hooray for Blue!
At +9 she's back in yellows but we celebrate all the wins here with FD. Lol What a great way to spend the day! Hope you girls had fun!
We did have fun today. It's not unexpected for her to get back into yellows. She seems to be doing the classic Lantus "smile" curve (not all cats do this, but a lot will). So she may be still higher at PMPS, but what we definitely have our hopes up for is no pink.... hold on to those yellows, Cleo!
Hi all. Hope you're enjoying this beautiful day! I would really appreciate a look at today's AM cycle. I am befuddled. AMPS 296 thrilled it was yellow (ignoring meter variance bc it makes me feel better its yellow not pink lol) +3-349 wasn't surprised...thinking food bump or bounce from night cycle. +6-237 ...respectible number for nadir considering her patterns and tendency to surf in yellows. And then...... +9-143.... befuddled.
Oh now that is interesting. Usually we see those late nadirs with bounce breaking cycles but (a) that hasn't exactly been her pattern so far and (b) her SS isn't screaming "bounce" at me. So I'm left with throwing a dart at the board - you might finally be breaking through some toxicity and it's shifting her cycles a bit And OF COURSE she pulls the lovely blue preshot when you won't be around!
At pm+5 we have a 138 blue! Wasn't expecting she would clear the bounce and reduced dose from yesterday so quickly. Just fed a lc snack. Should I set an alarm to test and feed?
You could test in another hour or two if you're curious but I don't see her dropping too much lower. I'd leave her a snack but she should be good! Fingers crossed this is the start of breaking through all this
Great thanks. I'm really sleepy lol and she's counter surfing and knocking things down. She wants more food. She'd eat an entire can in one sitting if I left it out. Let's see what the AMPS brings. Have a great night!
Good Morning @FrostD and @Suzanne & Darcy I don't want to get ahead of Cleo by increasing too soon but I also don't want to keep her too long on a dose that's probably only seeing high blue nadirs at best. Question for you... Does the token dose given on 4/16 PM shot re-set the cycle clock?
Let me look, but usually anything that is less than the full dose (fur shot, BCS, etc.) resets the count of cycles.
Tonight will be your sixth cycle after the token dose was given anyway... so you are close to increasing on the MPM method. But also, you were seeing blue on three units (before the token dose and even after.) You may want to consider holding a little longer.
Having said all this... and looking and looking at Cleo's spreadsheet. If sweet Cleo were my kitty, I would do a .25 increase tomorrow morning. @FrostD what would you do? Of course, this all depends on what happens the rest of today or tonight... this is assuming she kind of stays where she's been the last few days.
I really wish I shot a full dose on 4/16 PM but I was not around for 5 hours and over 25 miles away, to monitor. Better safe than sorry...but I really wonder what would have happened. Thanks so much for the info. I thought I remembered reading somewhere and a few times that Fur Shots, token doses etc re-started the cycle clock. I'll try to get some extra tests in this PM cycle so we can see what this dose is really doing but it hasn't given us the lower blues like we'd like to see. Plus she's seeing more yellows (chronic pattern of hers) so I've been thinking of giving her a nudge forward.
The 130s aren't bad, and yes that does reset cycle count. See how she does through tomorrow...if nothing lower than the 130s I'd increase on Thursday
Melissa - if this is you on 1/2 a brain - color me IMPRESSED! What are you like firing on all cylinders? Thanks Ladies. (I feel like I have my own cheering section with you two )
Lol! In what feels like another life I was an engineering manager, and also taught essentially robotics (technically automation and process control but most people aren't too familiar with that) at university as adjunct professor. These days I change a lot of diapers, sing a lot of ABCs, and analyze diabetic cats' spreadsheets so I don't go insane
I used to work as a Congressional Liaison/Washington D.C. Information Manager to one of the National Laboratories. That was my former life. It's okay though... I've decompressed a lot.
Oh my goodness...that's one of my worst "fears" with the way all this covid stuff was going. Some of the things school districts were thinking about requiring...I'd home school first. I could do it, I'd just go stir crazy. It's definitely a change, that's for sure. Took a little while to adjust, it's better when the weather is better and we can get out
@FrostD So its Thursday and I didn't do the .25 increase but I did give a Fat3 this morning and 3 in pm. I just tested her at +5.25 and she's 116. Do you suggest I put on a pot of coffee to test more or just leave out some extra food?
I was just making my rounds! This is so great! I suspect she's past nadir, plus this is a pretty gentle curve. I don't see her getting close to 50 tonight. I'd give her a little LC, check in 30 mins. If she's pretty close to flat or up, call it a night. If she's dropped into 90s, that's your call. You can stay up and do the "LC and test every so often" dance for a little while, leave out just LC, or leave LC mixed with a little MC, your call based on comfort level and sleep needs lol I *think* she'd be ok with LC, but she's in a fair bit of new territory here
THANK YOU! I wasn't 100%certain about her nadir so I'm glad my professor is around! Speaking of comfort level, I lowered my preshot number from 200 to 150.
I like to see it I think that should be ok at this dose and with MPM (as always, assuming you can monitor). But if she starts to come down more at this dose, probably better to lower to 175 first (and below that some sort of sliding scale)
Don't laugh at me...but I put a dosing sliding scale with conditions as a separate tab in my SS. I'm a data freak lol!
Ha! I used to have a paper flowchart that did the same thing. Are rows 10-12 if you can't monitor? If so I'd suggest splitting the 75-149 range into some smaller ones. And what's the last section for?
Good tip..will definitely break up rows 10-12. thanks! So first section is me home to monitor (test her bg) and feed. Second is if DH is home to feed but he doesn't test her bgs. He's squeamish at the sight of blood (sigh) but he's gotten pretty good at reading her behavior. And the third section is if no one is home. Still toying with the last section and my comfort level with giving insulin and no one around but last Saturday taught me she needs something more than a token dose.
Sorry crazy day, I saw this this morning and didnt get a chance to reply. Makes sense! If your curve tomorrow doesn't see green, I'm laying down the increase threat Cleo!
You had one heck of a day yesterday for sure! In my (not so humble) opinion, you handled yourself so well. Your posts yesterday were well reasoned and eloquently explained. I think that the original poster misunderstood and inferred a tone of you taking offense whereas I read them as a diligent advocate for a cat with personal experience of perhaps a similar situation. I told Cleo this morning about your threat. This increase is recommended pending no greens because (1) she hasn't seen any greens on this dose and (2) today's AM cycle would be the third cycle after the 116 the other night. (Is this right?) I've been thinking and hemming about something else then DH brought up what I was thinking. Cleo seems to give us better numbers and is less ravenous when we feed her anything other than the chicken pate. We've also noticed that when we give her venison, rabbit, lamb and mackarel, she is fuller longer. Coincidence....maybe. She might be less hungry bc she's seeing better numbers and we've broken through some toxicity... or is it the chicken. She still eats it and loves it but she's not Full from it. Maybe I will investigate the protein ratios in each flavor. I don't know. Now I'm rambling! Sorry. This morning's weather report brought to you by Cleo has a Sunny Yellow start with anticipation of BLUE skies and green waters. Kiss your kids. Hold hands and skip with your spouse! Get out and enjoy your day!
It is hard sometimes to convey a "stern" and serious/urgent tone on the internet to get a point across without others misinterpreting it as something else, such different communication styles. I'm glad it worked out in the end...I've seen it not and those are the worst. And correct - if she was seeing green (and I don't mean like a single 99) you'd tend to hold closer to 5-7 days, but with MPM now we do want nadirs closer to 50 (60-ish is pretty ideal). Perhaps something in the chicken is bothering her? Check ingredients?
Didn't think I was going to have an active cycle (high yellow preshot and basically flat at +2.75) but Cats LOVE to prove their humans wrong. She was acting weird at +4.5 Meowing and Pacing and light pawing at me. FYI the "light pawing" is weird. It's usually more heavy paw-handed lol. I thought she can't possibly be hungry she had a snack at +2.75. Well colored me BLUE with surprise. +4.75 - 110
I think she had to do it to not make YOU mad. Now do you think I can use your "threats" to get my husband to do stuff - Like laundry maybe even some mopping??!!?? Do I still increase at pm shot time if no green? If she were your furbaby what would you do? I was soooo Confident to shoot full dose at anything over 150. I almost feel silly feeling anxious over an increase but I will admit...a little anxious. I thought the color blue was supposed to be a calming color. I'm so needy lol. Another odd tidbit... I haven't fed her the Ziwi Chicken in 6 cycles. The last 6 cycles have been better. She has eaten unseasoned shredded home made chicken thigh/breast/heart/liver as a treat but no Ziwi Chicken as a meal/snack.
OK NOW I KNOW YOUR THREATS ARE GOLDEN or shall I say ....GREEN +6.5 - 75 going to test again in a hour. I'm so excited. For once the weather forecast was right! Where do we land on the increase now?
Woohoo! Now you hold current dose or at least 5 days. As for human threats...I've used most of those up on my husband and kids
Not just blue but green! She wanted to make curve day more interesting. She also didn’t like the increase threat. She reads all the posts on her condos, you know.
We have had several talks on car rides about just how many of his nine lives he's used up! (Btw we increased cab frequency and that seems to have offset the methimazole-cab interaction that was raising BG, back into good greens) *well, technically it wasn't enough cab to offset the growth hormone but you know what I mean
EOD. He was actually dropping into the 40s when we did EOD before, and that south American study actually backed one cat down in dose or frequency (can't remember which) because of it, so figured I'd try. I had him on once every 1.5 weeks for awhile actually! And I'd have tried spacing it out further if the thyroid hadn't cropped up I'm just winging it over here ...
Ok help out the newbie here. I know cab is one of the treatments for acro but what is methamizole and what does it do/ treat? How's Mr. Kitty's overall disposition? Does he act like he knows he's got these diagnosis?
Methimazole treats hyperthyroid (the other treatment is i-131, it is curative treatment but $2k+ and requires quarantining and stuff; they can also do surgery but no guarantee it gets everything). In humans, methimazole interferes with cabergoline's efficacy. I'm flying in no man's land here because literally zero data on cab + methimazole in cats, barely anything even on cab bring used for acro. Hyperthyroid also masks CKD (kidney disease), and with his kidney values I suspect I'm going to have to deal with that as well. The next fun thing I've got coming up is dealing with the IBD/SCL. Prednisolone is my choice for that, but surprise surprise all 3 meds work against each other in some way. So I'm trying to get thyroid and acro stable first - then deal with kidneys - then deal with IBD/SCL (since it's the least life threatening of all of them). I joke he looks like Franken-cat on paper. And nope, you'd have no idea there's anything even wrong with him. Truthfully that's whats kept us going with him this long, through multiple ER trips, multiple advice to put him down, etc. Just isn't ready, not his time. Still runs around, comes to see and sit with everyone, sleeps with me purring all the while. And thankfully I've found a vet willing to humor me with pretty much everything I want to do/try
Wow that's a lot. I'm assuming you've already done tons of online research, but maybe you're interested in this book (cheaper if you have a kindle) or I will get myself a copy and loan it to you if interested. https://www.amazon.com/Feline-Endoc...t=&hvlocphy=9004382&hvtargid=pla-736127661107 It's the first of it's kind written by Vets and solely for felines. I also found this excerpt https://pubmed.ncbi.nlm.nih.gov/24951346/ but I cannot access the whole study. I also remember reading right before Cleo was dx with FD, that a lower iodine diet showed promise and was beneficial to delay the progression of CKD in hyperthyroid cats whilst undergoing non surgerical treatment. Before we got the FD dx we thought her clinical signs pointed to hyperT. Boy did we research in the wrong direction. Diabetes didn't even cross our minds. In any event I'm sure I saved that research on my work PC and will definitely look for it on Monday. As an aside, Cleo bounced to the moon from that 78 @+10 lol. I'm sure you and @Suzanne & Darcy expected this.
Thanks! I did see the lower iodine diet, the trouble just becomes balancing all the needs - low carb, low phos for kidneys, novel protein is ideal for the IBD/SCL, low iodine. It's a mess. I know I really should do raw but that has its own challenges.
