4/6 Cleo PMPS 201

Angela & Cleo

Angela & Cleo

Very Active Member
As Melissa predicted @FrostD , Cleo threw a high red at AMPS on the alphatrak2. Yesterday she was pretty flat both cycles and thinking there wasnt a need to keep testing after pm +6 - DH said she was doing the Waltz dance lol. Perhaps she went lower after that and bounced to AMPS or maybe lower carb food?
Any suggestions on testing today?
 
I see your notes - if she's hungry go ahead and feed her more (assuming she's not overweight). Just small snacks only after about +5/6.

I don't think she went lower. That said, I'm a bit surprised by the AMPS, it is possible she bounced just from that extended time in yellow. Let's see how she does tonight, when's the next food % shift?
 
Thanks for checking in. Just got 420 @ +3 on AT2. At this time she got 1 tsp of Ziwi Chicken (low carb) and 1 tsp water.
We usually feed at shot time then snacks at +3 +6 and +9. Sometimes its +2, +5, +10.

Shes about 10lbs.
Day of dx (1/3) she was 12lbs. she lost almost 2lbs thru 2/22 since we removed all free feeding dry from her diet. Vet said her body condition score was perfect at every visit so far. DH wants to feed her more. I am trying to stay within 200-300 cal/day. And shes always hungry and would eat an entire 5.5oz can if I left it out.
Schedule today is super flexible bc home all day but since she's so high I just might give her ears a break until +10 then reassess pm testing schedule.
You mentioned in yesterday's post having an idea for feeding schedule. She has taken well to the ZiwiPeak pate very well and this morning's breffy was 50-50 LC DM.
As always I am eternally grateful and value your opinions advice and hand holding!
 
Hmm. If it were me I would feed her the extra, just nothing exorbitant.

Few reasons:
She has some wiggle room, not currently overweight. You can always weigh her every other week on a home scale to keep a loose eye (I wouldn't do more frequently because they don't gain weight that quickly, and even something like a full bladder and poop can affect it quite a bit)

When they are unregulated they can't process the food as well. You may notice she's more hungry in higher numbers (and also in lower numbers lol).

If she's getting hungry at certain times early in the cycle, that's actually her body helping you out. It feels the drops coming/happening, and tries to slow it down.



I free feed my cat. I set out a can in the morning, and again at night (when he was unregulated he was actually doing 4-5.5oz cans a day, his ideal weight is 14-14 lbs). He actually fed his own curve which made things much easier for me. He ate the bulk of the food early in the cycle while dropping, then barely touched anything at all in the later part. Kept him fairly nice and flat every cycle, almost never bounced.

But - some cats will just gobble it all up at once and it shoots you in the foot if you have to intervene with food later at low numbers, because they won't be hungry. I think it's worth an experiment though, leave food out and see what she does.

The idea behind meal timing is you want to strategically feed to keep the curve as flat as you can. Going off the night data, you can see she starts to drop sometime after +2. It's not a bad drop compared to others I've seen, but it could be slowed down a bit. So the snack at +2/+3 is perfect, just may need to tweak amount to slow it a bit more, and possibly another +3/+4. Some cats cooperate, some don't lol

The other thing about "feeding the curve" is a flatter curve allows you room to increase the dose to get all numbers down overall. Some cats plummet from 350 to 90 daily which is a rock and a hard place - no room to increase insulin, but still unregulated. Sometimes meal schedule helps, sometimes have to change insulin.
 
Thanks as always :). This AMPS might be a reaction to lower carb food ...her own bounce per say. At least that's my gut feeling. Her snacks am and pm yesterday were mostly LC with little DM mix and some were all LC. I will feed her whenever she asks for it but cant let her free feed anymore at least not yet bc she just eats it all at once.
 
Hi Melissa,
She is now 50% new food and 50% DM. I already shot the 1.5U for pm and plan to get a +3, +6 and hopefully a +9 tonight. Do you think its too soon to increase to 1.75 tomorrow am or do I need to chill out?
 
Yes I would, I've been hemming and hawing since there's a transition but she's pretty high.

It is a bit odd - the ziwi peak is definitely low carb, I wouldn't expect numbers this high. No diarrhea or vomiting? Any scratching or excess grooming? (Ruling out food allergy sort of thing raising BG)

No chance of infection/illness? Do her ears maybe feel hot to the touch?
 
She is an enigma! Her poops have been less offensive since starting the switch. No vomitting. No itching or scratching. Grooming as per usual.
She is not showing any signs of illness. Still need to warm up ears to get a test. Vocal on her normal schedule too.
Maybe she's carb INsensitive - in the opposite direction lol! Is that even possible? Lol.
Going to increase in the am back to 1.75. Thank you so much.
PS With a caregiver like you Mr Kitty is very lucky (he will do great with you in his corner) and so are your human babies...including the one on the way. CONGRATS!.
 
It's weird for sure! Maybe just some glucose toxicity. It's the canned Ziwi Peak pate right?

We've had some manufacturers slyly change ingredients during the pandemic thinking it wouldn't matters, but it does for diabetics! What are ingredients on the can? I e not yet heard of Ziwipeak being one of them, they're pretty reputable

And thank you! We know he's on borrowed time at the moment, diagnoses are kind of stacking up against him. But, one step at a time. He's a happy playful guy and that's what matters. Treat what we can, keep him comfortable. I'm running out of signature room....
 
FrostD said:
It's the canned Ziwi Peak pate right?
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Yes

FrostD said:
Maybe just some glucose toxicity.
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I think so too based on reading all your posts helping others. Im not a stalker. Im a learning lurker :bookworm:

FrostD said:
What are ingredients on the can? I e not yet heard of Ziwipeak being one of them, they're pretty reputable
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Great Minds think alike!
I actually emailed them last night asking for clarification and an affirmation that COViD or any other supply chain issues has/has not affected products. Will definitely post on main forum with their response.

FrostD said:
He's a happy playful guy and that's what matters. Treat what we can, keep him comfortable
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Truer words have never been spoken! It took me longer than I care to admit to accept Cleo's dx. I just wanted her cured at first. Now I realize that her happiness and quality of life is soo much more important and that is what She needs from Me.
With all you have going on I am just in awe by you...helping sooooo many of us; dealing with our impatience and incessant questions and demanding explanations. I dont know how to thank you for all the hand holding. I am eternally in your debt...truly...
 
Good Morning!
The PS#s are slowlyyyyy coming down. Still red but no more black#s. With FD we celebrate all wins...even the little ones lol. This morning though I found poop in the kitchen. Very unlike her to go that far away from the box. I do think that based on what I found (will not get graphic) she might be slightly constipated. I thought I read somewhere that a higher protein food could cause this especially during transition and adding a probiotic or additional moisture could help. I'm open to suggestions:bighug:.
Have a great day.
 
Thanks for the recommendations. Vet recommended on 2/22 to give fortiflora every couple of days. She loves the fortiflora but really not the best probiotic and wanted something a little better.

FrostD said:
but I'm not sure that's the entire explanation here
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AGREED! This is the only little clue she's given me. And she's giving me a little harder time recently with testing.

FrostD said:
I would increase again on the 2nd if you don't see any blue
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Absolutely will increase on 4/2 pending no blues. Her PS #s are down a wee bit but I really need to find the dip/nadir. Might need to take some time off of work - don't tell my boss ;) - to test more during AM cycles during the week. I need more data!
Ok - rant over - thanks for listening.
Have a great day.
 
I wonder if it really just is the difference between meters...

I don't want her this high (ketones risk) - if you can get a +5 ish tonight and it's pink or higher, increase tomorrow instead of the 2nd. You could choose to increase by 0.5U, as that's what we recommend when nadirs are above 200. I am a bit hesitant to say go for it, because there is a small chance she's going lower during the day - plus you can't be home to keep an eye on her
 
I took a look back at the spreadsheet and I did get some pinks and one yellow on the pet meter 3/14-3/19 before running out of strips.
Just tested at +2.5 and she's down 141pts since shot time with a reading of 418. I gave her a snack and will get a +5 test which is 11pm EST. I will follow your advice for tomorrow morning and if PM+5 is pink+ will increase by .25 in the am. Thanks again. Get some rest!

ETA +5 reading is 542. Raising to 2U in the am.
 
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Hi @FrostD
So I received my order of the strips for my human meter, freestyle lite (FLM) today. I took the PMPS on the AT2 and got 551 then fed and shot 2 U. About 10 mins later I decided to use my newly arrived package of FLM strips and got 304. I tried to get another test in but Cleo did not cooperate. I know there is some meter variance but this is extreme no?
Now Im a little worried about her dropping low. I will put on a pot of coffee and I scheduled to work from home tomorrow so I can continue to monitor her. Could you please opine on:
1. Onset isnt until +2 (8pm est). When should I test?
2. Which meter would you suggest? I am willing to put this to a vote on the main forum (lol) with the experts.
3. Based on tonight's test results what is the range to shoot in the am?
Thanks in advance!
 
I would retest again on both meters now or whenever you see this. I suspect it's a sort of "split the difference thing" but we do know pet meters read higher overall.

Either way, I'm not too worried, and don't lose your mind over the difference lol I don't think it matters which meter - nadir is the most important, followed by the preshot being above 200. But this is why we say stick with one meter as best you can - when she does eventually get down to lower numbers, your data will show it's safe to shoot X at Y preshot range based on whichever meter.

And remember the meter variance is much much smaller/not as big a deal at the lower numbers, and we do factor in pet vs human meter for different reduction points for the more aggressive dosing methods to be safe

Most people tend to ditch the AT just due to cost.

Convenient you have the curve planned for tomorrow, if she's above 200 I'd shoot the full 2U - unless she goes below 90 tonight, that's a 0.25U reduction. I don't see her being below 200, but if she is I think you're looking somewhere around a 0.25-1U dose....close to 150 I'd be thinking 0.25-0.5U, closer to 200 I'd be thinking 1U. I'd skip below 150
 
You deserve an award for how clear and concise you express yourself.
I'm officially off the ledge and will be using the human meter going forward. And lesson learned to not run out of strips. Putting that on autodelivery.
Thanks again.
 
Don't worry about that with me. I appreciate succinct communication plus Im not that sensitive lol! Im a NYer Ive got tough skin. My baby Cleo is my only weak spot.
I just tested at 2.5 and shes at 180.
 
Angela & Cleo said:
I would increase again on the 2nd if you don't see any blue, I see you have tests planned.

I think the vast majority of us use s boulardii, just make sure no added sugars. I use Jarrow with MOS - https://www.iherb.com/pr/jarrow-for...h8uf7GubyBtV459ar65Y6ZRMYPj0GDG8aAlwsEALw_wcB

But there are others like Visbiome as well.

Constipation can also cause slightly higher numbers but I'm not sure that's the entire explanation here
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I give Panzer & Spook 1/4 tsp of MiraLax once a day at feeding time, that seems to keep them normal. Panzer also gets probiotic with baby food once daily & d Mannose, but as you know he is struggling with that ever lasting UTI at the moment.
]Good Morning!
The PS#s are slowlyyyyy coming down. Still red but no more black#s. With FD we celebrate all wins...even the little ones lol. This morning though I found poop in the kitchen. Very unlike her to go that far away from the box. I do think that based on what I found (will not get graphic) she might be slightly constipated. I thought I read somewhere that a higher protein food could cause this especially during transition and adding a probiotic or additional moisture could help. I'm open to suggestions:bighug:.
Have a great day.[/QUOTE]
 
She's completely low carb now right?

If so, I would take her up to 2.25U tomorrow since you already have tests planned. I'd hate for her to sit another week at the 2U, the glucose toxicity can grab hold again.

^That advice technically follows MPM which would require additional tests day and night, but I know you aren't always home and able. This is where we have to be a bit flexible - her numbers are high enough that the increase won't put her in danger. The way I see it, it's worse to let her sit at the current dose for another week than it is to increase a smidge on the early side without daytime testing every day - and you already have a curve planned tomorrow so that would give us a heads up if something odd may happen with the new dose. Technically per MPM you'd go up 0.5U, but I think 0.25U is good compromise

If you start to get lower than usual preshots (like 250/275 ish) then we'll want to think a little harder about it.

As always, it's your comfort level/desires on how to manage the FD.
 
OMG PLEASE DON'T BE MAD AT ME. I shot 2.25 this am before reading your post!
I worry about glucose toxicity and yesterdays yellows (am and pm) looked exactly like the 3/23 yellows then spike in the SS. It may have been just meter variance but the trend is the same. Two to three cycles in one color range seems to cause a spike shortly after. I figured that since I am around for the next 4 cycles to monitor and we are feeding whenever she asks that it wld be ok.
 
Why would I be mad it's exactly what I was thinking anyway lol I only ever get mad when people come on here and get rude and disrespectful, but that's very rare
 
I value your expertise and opinion and I was a little apprehensive to increase w/o asking you first. I am so glad and relieved!! Guess all that learning lurking :bookworm: is starting to pay off. I had your words in my head when I decided to up the dose "comfort level" "look back at your data" "used to higher numbers" and "glucose toxicity".

Interestingly Cleo didn't look for a snack until about now which is +3.5 (typically she wants her 1st snack at +2 - +2.5) and bg was 182.

You are NOT off the hook. I have soooo much more to learn and would love to continue learning it from you! I'm comfortable now shooting and feeding in the yellows and pinks but I am going to need hand holding and talking me off the ledge with blues and greens!
 
Nice blues :cool:

What you're seeing is not enough duration (you can see how she's climbed back up by +8...ideally she needs to hang out lower and climb up slowly to +12). It's very common when numbers are high + dose isn't quite right. When you get to a dose that keeps nadir around 90-ish, her numbers overall should start to come down slowly and duration should increase. For some cats that happens quickly, for others it can take weeks still

...and then some just never get the duration needed and end up switching to a depot insulin like Lantus lol
 
I thought the pmps would be much higher since I got the pink at +8. I am happy with today's #s and progress all things considered. Especially because she stayed flat from +8 thru pmps even with a snack at +10. Ideally it should've been yellow @ +8 and then pink @+12 but flat for 4 hours isnt half bad. We celebrate the little wins around here with FD lol.
Do you want any specific +tests tonight and tomorrow? Cleo wanted me to ask that :cat:. She's very appreciative to you because she gets to eat more often. I told her it was your suggestion;).
 
Hey (@FrostD ) Melissa
Hope you are having an awesome day!
Cleo had a follow up vet appt today and REFUSED to get in the carrier despite 2ml Gaba and tonsssss of coaxing. So I had a phone consultation with the Vet. He said to up her dose to 2.5units for two weeks.
Too soon?

He also said that if she isn't regulated at 3 units he wants to switch her back to Lantus. (his criteria for regulation is preshots <250 and nadir around 100 on human meter).

ETA PMPS 249 shot 2.25units.
Silly human was going to listen to Vet. Good thing for home testing and insulin protocols on FDMB. :rolleyes:
 
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Now that is curious...some cats do actually drop BG when stressed.

I do think she could use an increase again, but first I'd rather try to see if today repeats itself.

As for Lantus, it's really up to you. She needs more time on ProZinc to really settle in, we usually say give it 1-2 months of actively following our guidelines. That said, most cats do very well on Lantus and tend to do better more quickly.

If it were me...I'd run out the vial first before switching if that's what you want to do.
 
Side note: I actually have to throw a towel over Mr Kitty and shove him in to the carrier or it won't happen. I now have one with a removable top, so I leave the top off. Grab him completely covered in a towel (including head), drop him in, get the top on
 
I'm not ready to throw in the ProZinc towel just yet (and Cleo is faster than me and my husband to get the towel around her!)
After last night's and this AM's numbers, she is holding (AGAIN) in the 200s. I'm inclined to increase this evening to try to break through. Thoughts?
 
Yep, onwards and upwards

Fwiw we've had cats here on ProZinc with pretty high doses...so it's not necessarily "ProZinc isn't working if you hit 3U". It's just, they need whatever dose they need. If you switch to Lantus, it would still likely be around 3U.

The signs of ProZinc not being suitable for a given cat are more like hard and fast drops (think like 350 to 90 in every single cycle), so you can't safely increase to bring down overall numbers, just a vicious circle. Or in the case of my cat, he was just acting weird on it...not himself at all. Sometimes they don't get enough duration either.

For whatever reason vets think 3U is a magic number at which all cats should be perfectly regulated...or else it's just bad insulin and we'll switch and restart at 1U (bad idea btw).
 
FrostD said:
Yep, onwards and upwards
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Done and Done. I'll get a +3, +6 and (hopefully) +9 tonight.
FrostD said:
Sometimes they don't get enough duration either.
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At this point, I think Cleo fits in this classification.
FrostD said:
For whatever reason vets think 3U is a magic number at which all cats should be perfectly regulated
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I like my Vet even if he has a bit of a superiority complex. He did say to me yesterday "I've been able to get every cat regulated on any insulin". All I can say is "sigh"
 
Oh boy...cool story bro

But yes shirt duration is common while unregulated. The majority of cats gets good/proper duration once they're at the right dose.
 
I changed the thread title to today bc got a lower than usual preshot at pmps of 201. I gave a skinny 2.5U. I am around to monitor tonight which is why I pushed the plunger but between you and me (and anyone else reading this) I am a little nervous.
I know I can monitor and its almost ridiculous to even think not shooting a full dose with a 200 preshot # when you can test but that reduced dose thought did cross my mind.
 
Ah you shot and 249 and 271 before, gotta take the risks to get the data! (Reasonable risks of course lol)

It's ideal to lower what is shootable by 25 points or so at a time, but honestly they rarely cooperate that well. I think you'll be fine!

It actually gets addicting...
 
Good Morning!
So got a few tests in last night and studying the SS. I interpret this data as time to increase.
Please correct me if I'm wrong but here are my reasons (1) nadir above 200, (2) haven't seen any blues in 4 cycles, (3) the 200s seem to be her new normal (again) therefore increase to break thru glucose toxicity (esp after shooting a 200ps value and no subsequent blues), (4) similar patters 3/26, 4/1, and 4/4 and (5)
I am around to test whenever tonight and tomorrow day through +9 and back in time for pmps and shot.
Thoughts, opinions, critiques....please feel free to be as blunt and honest as you want...all data is good data and you are my data guru!
 
Hey we'll take 140!

Expect a bounce from that though. Does she eat around +2 at all? Probably want to give a small snack each cycle to hopefully slow those steep dives she sometimes gets
 
Do you ever sleep?
I started a snack around +2ish so I could get a test in before leaving for work. Like you suggested I've tried to listen to her more and smother her a little less with feeding regimen and she's all Ziwi now except for a smidge DM with meals at shot time. I do have to add water to the pate or she won't eat it.
Thanks a million for checking in on us.
 
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Angela & Cleo said:
Do you ever sleep?
I started a snack around +2ish so I could get a test in before leaving for work. Like you suggested I've tried to listen to her more and smother her a little less with feeding regimen and she's all Ziwi now except for a smidge with meals at shot time. I do have to add water to the pate or she won't eat it.
Thanks a million for checking in on us.
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I snorted at that :joyful:

Honestly, I need time to decompress after kids go to bed and house is cleaned up, and this is one of the ways I do it lol I've kind of adjusted to 6-8 hours and broken sleep (babies and diabetic cats tend to make that happen lol). I also just can't leave people hanging if they're having trouble, so while I wait for replies I try to catch up on the other cats.

You're always welcome. You may want to make that snack a little bigger, or increase the carb %. The trick is she doesn't always dive, or dive at the same time.

Something interesting, that may shoot you in the foot, is I would often leave two snacks out. One regular LC, the other usually an MC or LC/MC mix. Every time, without fail, he went for the one he actually needed to slow it down. I really don't think that works for many cats, especially if theyre picky, but just a thought.
 
Pre dx I would leave wet and dry food out all day and night and she would graze on whatever flavor tickled her fancy but now she will devour any and everything in sight. She even licks the spoon.
I just tested and she's 122 at 5.25.
Should we start making bets on how high she's gonna bounce lol.
 
Before AMPS Cleo and I had a little talk. I explained to her that YOU said no more reds. AMPS 284 and shot full dose.
She seems to listen to you...I plan to use this to my advantage for example Melissa said you have to clean up all your toys.:smuggrin:
 
Hi @FrostD Hope you're having a good weekend. Nothing urgent here. I was just curious about distinguishing between a bounce and the need to increase. I am assuming the answer lies in the data in the SS.
I understand that a bounce can take up to 6cycles to clear and I understand that doses should be held for 3-6cycles before increasing but how can you tell one from the other?
Thanks
 
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