Diet change working wonders! Now concerned about high insulin dose

Link to previous thread: https://www.felinediabetes.com/FDMB...ing-neuropathy-considering-euthanasia.289997/

First off I just to say thank you to this wonderful community. While me and Fluffy still have a long way to go for real regulation, I'm seeing signs of a remarkable turn around. The information I've been provided here may very well be responsible for saving my best friends life.

Fluffy has taken remarkably well to the diet change from a high carb dry food to a low carb wet food (fancy feast classic chicken feast). We are almost done with the transition and over the next few days he should be on a 100% wet food diet.

I'm seeing a drastic reduction in his overall blood glucose levels. I'm going to be testing vigorously over the next few days since I'll be off work. But the drastic reduction of numbers has me concerned about his high dose. He's currently on 6 units of prozinc as instructed by his previous vet ( who I've moved on from). I am concerned that since it's such a high dose I may be putting him at hypo risk over the next few cycles if the numbers continue in the same trajectory. I'll be testing overnight to have a decent idea of his cycle numbers, but am looking for feedback on what I should do for his next cycle and subsequent cycles afterwards.

I never expected the diet change to have this much of an impact so wondering if I should mess with dosage and go a bit lower to be safe while I find a happy medium?

 

Hi there! I’m really happy that you have almost completed the transition to LC wet food. You certainly saw some much better numbers last night! How wonderful to see a blue on that spreadsheet after seeing the nasty reds and blacks. Oh, before I forget, your spreadsheet date for today says it’s the 16th of May and needs to be changed to the 18th.

If you can get as many tests as you can over the next few days, we will have a much better idea of whether or not it’s a good idea to lower his dose. We need to find his nadir. Did he have all low carb food last night?

 

Ah good catch with the date, totally missed it.

And mostly low carb, his meal split last night was at least 80 % low carb wet food and 20% Purina dm dry food, if not a little higher wet food percentage. I just took that +5 blue reading about 20 minutes ago so he has about another 6 and half hours before his next meal and subsequent dose.

I'll try and get a reading each of the next two or three hours. He might be a little upset at me for waking him up multiple times though

 

And will he be doing all low carb today? And you will be testing? And you have karo syrup and HC food ready if needed? With the Alpha Trak, your take action number is 68 - so no HC food unless Fluffy drops below 68.

 

That was a very high blue last night (almost yellow) so I think you have some wiggle room even with the low carb transition - especially since that was at +5 and must have been close to nadir. He would have to drop a long way before getting close to 68. The best way to approach this is to just test your sweet boy a lot so we can see the full effect of the LC switch.

 

My intention was to keep the split similar 80/20, maybe bump it up a little if anything. I'll be testing as much as possible but may need to get a couple hours off shut eye here and there.

Unfortunately I'm embarrassed to admit I'm a little unprepared for a hypo event. I've been at high 500+ levels for so long that I never thought I'd be anywhere near such a scenario. That's partially why I'm trying to be as cautious as possible.

Edit: My local stores won't open for a few hours but I'll make a trip to pick up karo syrup and some HC wet food when they do

 

https://felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/

 

https://www.felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/

 

So you are not planning to cut out the HC food? That’s going to make things rather wonky and complicated. The HC will raise BG for a longer period of time (especially if it’s dry food) and could influence numbers even into the next cycle. It’s going to be hard to interpret spreadsheet data with HC food involved. At least you will need to chart on the SS what food was given and when (at which +hour.) You do know already to not give food for two hours prior to the preshot tests? And to not feed after nadir? I see you have a long thread over on the Feline Health forum, but I haven’t had time to read through all of it.

 

Agree with Suzanne, test, test, test as much as you can while you can. I'm really hoping he doesn't bounce for the next 3 days from that lovely blue - we should be able to tell though, from the numbers you gather.

Are you CST time zone? What time do you shoot? I'm coming up with 1am/pm your time - I probably won't be around for your shot times, but, I have a chance to be around a bit more this coming week & am anxious to see how Fluffy does!

 

That is correct I shoot at 1:30 pm and 1:30 am.

I'm off work for 3 days starting today so I should be able to get some pretty consistent testing numbers

 

Oh yes I'm very much planning to cut the HC food out completely. Fluffy was just a dry food cat his entire life up until 4 days ago. So my goal was to transition using a mix over the course of a week so as not to upset his tummy.

To clarify though, I am strict when adhering to test/feed/shoot so other than a small freeze dried treat during testing he has no food influencing testing during other points of the day.

 

Ok so just did his AMPS reading and it was back up to 483. A little bit of a bummer but I'm still optimistic we are trending in the right direction. Also allays my fears about the high dosage for the time being so he's getting his usual 6 units. I'm also confident his tummy is taking the wet food well so starting this morning he's on a pure LC wet food diet.

Also I purchased some karo syrup and HC wet food in case of an emergency. I'll be updating spreadsheet throughout the day today as well. Going to do everything in my power to gather as much data as possible.

 

The feeding schedule should be something like this: meal at AMPS and PMPS.
Snack at +2
Snack at +4
Can also give a snack at +6 but not after cat’s typical nadir time.
Snacks can be 1-2 teaspoons of wet low carb food.
This would be for regular days. On days where you are steering low numbers you would obviously deviate from this based on the numbers (e.g. you may need to feed medium carb or high carb and you may be giving small amounts of food as often as every 20-30 minutes.). But this would be a basic daily feeding schedule. The snacks are important to smooth the cycle and prevent steep drops in order to help prevent bouncing.

 

I forgot to add that you can buy a timed feeder to dispense the snacks at the appropriate time of day while you’re working. This will be especially important to keep Fluffy safe while you’re away from home.

 

Uh oh, it looks like he is perhaps bouncing from the blue last night. His body isn’t used to being in numbers that low. Hopefully he won’t take too many cycles to clear the bounce! They can (but don’t necessarily) take up to six cycles to clear. Keep up the food transition (and yes, you are right to do it slowly to help prevent GI upset which cats are so prone to with dietary changes. Just be sure to write down in your notes section of the spreadsheet about where you are with the food transition and to note when he’s on 100 percent low carb food.

 

Ok this is really good to know. Probably would've been good to give one last nights when his numbers were going down at a high rate I'm assuming? I'll begin incorporating that soon for sure. Thank you.

 

Exactly. I was looking at your spreadsheet this morning and kind of wondering about that drop. It really is good for cats on insulin to have a feeding schedule like this. It can be tweaked over time, of course, as we see Fluffy’s patterns. I am really optimistic about Fluffy’s progress.

 

And I just want to say that Fluffy is completely adorable!

 

Okay. I am excited to see how well Fluffy is doing. He got right back to work with the insulin. I’m loving the blues. So far everything is quite safe numbers wise.

 

Oh wow, more blues! While those blues were very safe, my only concern, I'd be considering a dose reduction if you find you need to keep feeding HC to keep his numbers flat - it's a good strategy while you're home and can monitor, but, that's not always going to be the case. While you're available, I'd take the time to find a good dose that doesn't need HC intervention.

To me feeding HC at +4 that kept him flat to +5 suggests he would have more than likely kept heading down and hit green.

 

I agree with Shelley. Of course, green is good, but we don’t know how low he would have gone without the HC. It muddies the waters. As a general rule, we don’t give HC unless the cat drops below 50. The snacks should all be low carb and that should be enough to keep things in check. If not, then we know that a dose reduction is warranted. Of course, we will never let them just drop into unsafe numbers. You can even experiment with feeding a little higher end LC (like 8 or 9 percent carbs). Anything under 10 percent is still considered LC. If you’re having a really steep drop, some people find that they need to give a little medium carb. But you would be surprised how a little LC will smooth the cycle for most cats (unless, as I said, Fluffy needs a dose reduction.)

 

See above. Ten percent and under is low carb. 11-15 percent carbs is Medium Carb. Over 15 is high carb.

 

Sorry guys, I ended up kinda panicking a bit about seeing such a steep drop that I reached for the HC wet food to try and limit it so that the bounce wouldn't be as extreme. The 556 PMS reading just set alarms bells off for me.

But yes I'd love to hear your thoughts on a dose reduction. I'm off work the next 4 cycles but on 5/22/24 I'll be back at work and not being able to keep a close eye makes me a little nervous.

Any starting points y'all would recommend to try and test out ?

 

Oh! Don't ever be sorry for wanting to keep Fluffy safe!

Cats tend to bounce harder when the drop is more than 50% from preshot to nadir. You were at about a 75% drop at +4 and still had a couple hours to go until expected nadir - with so little data, you did the right thing!!

Feeding only LC now I'm thinking a 0.5 unit reduction to start - that 6 units cut through some pretty high numbers. Let's see what @Suzanne & Darcy thinks.

 

I would agree with cutting the dose to 5.5 units. I hope you have the syringes with the half unit markings. If you start right away with the next shot and feed low carb then we will be able to see how Fluffy does for the next 4 cycles while you are at home then we will have a good idea of how the new dose is working.

 

Looks like he bounced really really hard again. 671 the highest number I've gotten since I started testing. We also had apartment maintenance show up unexpectedly this morning to do work inside and there was lots of lots noise that definitely stressed him out so possible that contributed as well.


Trying the 5.5 units so I'll let y'all know how it goes.

 

Looks like we had a pretty good couple of cycles with the 5.5 units. I was a little nervous with the PMPS number being as low as it was and still giving 5.5 units given the drops we had seen earlier but it seems like he handled it well.

Is there a pre shot number that you would consider too low for the 5.5? If he is the 100s do you think I should do a half dose? Skip?

@Suzanne & Darcy
@Shelley & Jess

 

I'd really like to see how the current cycle behaves and maybe even the next. He's still settling in, it varies, but, it can take some cats quite a few cycles after removing all dry to see what the full effects will be. We've had 4 full cycles of no dry and 2 since the HC wet - we can't be sure just yet if there's any lingering effect left.

I'm watching for your AM+2.

 

Just updated results for am +3 and +4. I think we're still a couple hours away from nadir based on what I've seen? Kinda expecting to go into Green but we'll see.

Didn't test at +2 but I did give him his snack, and just now gave him snack at +4. Just for clarification the HC wet food I gave him a couple nights ago was a really small portion of the fancy feast grilled in gravy chicken. Maybe a teaspoon total.

I'm keeping a close eye next two hours to make sure he doesn't go too low.

 

As a reminder, 68 is the take action number for a pet meter. (50 if using a human meter).

And, good info about the HC fed, when we look back we can see how that small amount stopped the drop.

 

I’m looking at the notes for today and don’t see anything about HC. This is what I see for today’s notes

 

Was answering post #31

 

@FluffyP - re +5

I'd feed a teaspoon of LC and test again at +5.5.

You're last 3 tests have dropped roughly 30 points each, you don't have room for another 30 points if he keeps up that pace to +6.

 

Ok so looks like he hit nadir and is gonna make his way back up. +5 was 85 and +6 was 89. I also took a reading at the halfway point of those two (+5.5) and it was 84. I also gave him tiny little portions of pure bites freeze died chicken treats to help him through the testing process ( which I almost always do). Not sure if there's any kind of meaningful carbs with those but something to consider as well I suppose?

Those are really really promising numbers. Never thought I'd hit green so soon after switching foods. But it does concern me that we went all the way from 230 to just 20 points above the take action point. I'm thinking maybe a lower dose tonight if his pmps shows anything under 230? What are y'all's thoughts. I'm doing my best to stay up with him overnight but I've been really been pushing myself last 2 weeks or so and especially the last couple days.

 

Okay so… so far you have gathered enough data to sho us that the lower 200s are safe to shoot the 5.5 units (this is assuming that Fluffy doesn’t drop below 68 today.). Hopefully we can still get a little more data before you go back to work. Or is that tomorrow? You go back to work tomorrow? Well, we will have to be cautious until we can gather even more data. The goal is to be able to shoot lower preshots eventually, but you can work your way down when you are at home and can monitor the cycles. Tell me about how many hours you will be gone during your workday and when you will be home (what + hour.) ?

 

It’s great to see how he stabilized in healthy greens with only low carb. Don’t worry about the Pure Bites testing treats. It not a source of carbs to elevate BG.

 

I ended up taking the day off tomorrow so I'll be able to do another round of good data gathering, however, I will be going back to work the following day. I work 10 hour days so I usually have to leave the house at AM +1 and am not back home until it's time for PMPS. In my opinion that means I have to be EXTRA cautious with my preshoots. I live alone too, so he is unfortunately unmonitored during those times. I have family members than can occasionally check on him but not anywhere near enough to a consistent part of the equation.

 

If you do have a preshot for PMPS of below 230 — or even around 230, I might try cutting another half unit off the dose (to 5 units.). The thing is, I don’t think we have to rush this process. You can always increase if necessary if a dose just isn’t getting Fluffy into desirable numbers. I am wondering at what hour in the cycle you will return home. And you have an automatic feeder to dispense the snacks?

 

Gotcha. Sorry. I was just trying to make sure.

 

Yep, he earned a reduction going below 90. Thinking the same, I'd reduce another 0.5 units - new dose 5.0 units if he's high enough to shoot.

 

I am happy about the extra day. But I agree about being extra cautious until we can gather even more data on your off days so that you can be confident in your dosing. If that means Fluffy runs a little higher for the next couple of weeks then so be it. It will still be okay and better than the reds and blacks. We can do this incrementally.

 

When I get home it's already PMPS time. Maybe with anywhere from 15-30 minutes to spare. It's not ideal


Ok that's what I was thinking as well. Id very much like to err on the side of caution. I think I will go to 5.0 units if we're in the area of 230. I'm also not in a rush to be in a completely ideal situation. I'm completely ok going to 4.5 as well if it means being that's much safer as well. Given I spent 4 months being told to raise and raise the dose, the idea of reducing feels like a victory in and of itself.

My automatic feeder should be in either tonight or tomorrow so I should almost guarantee I will have it set up by the time I return to work.

 

It IS a victory! We should celebrate this progress. I was really happy to see a yellow preshot this a.m. cycle! We have time and we need to get this right!

 

In the event that he's sub 200 at PMPS in couple of hours would you all advise that I still shoot? Maybe a heavily modified dose? Somewhere around 4 - 4.5 maybe or less?

Figured I'd check in advance since it's usually pretty late for most NA members here by then.

 

If he’s under 200 at PMPS then yes I think you could try 4 units as long as you can monitor the cycle. Now if he had a preshot that was really unexpected like below 150, I would consider shooting something much lower like maybe 2 units. It may not be nearly enough insulin, but it’s all a matter of gathering data to see how he responds. I hope he won’t be that low actually.

 

Got it!

And just wanted to say thank you and to @Shelley & Jess as well. You've done so much to help me and guide me and fluffy. Not sure how I'd be doing this without y'all's advice and guidance. From the bottom of my heart, genuinely, thank you.

 

Oh, you are very welcome. It helps just to navigate these waters with some others. We are glad to do it.

 

@FluffyP
Hi if you are following SLGS method
When following SLGS with the Alpha Trak you reduce if the BG falls under 90. Which I see Fluffy did today .
I will tag Suzanne and Shelly just to confirm this
I assume you would reduce by 0.25 units so the new dose would be 5.25 units
Can you add to your signature SLGS and what you are feeding Fluffy
By the way Fluffy is adorable!
@Suzanne & Darcy
@Shelley & Jess

 

So I think what we did was a really rushed and not properly tested version of SLGS after his initial diagnosis and subsequent vet visits. He was diagnosed in January and they kept raising his dosage every month only doing monthly visits. He was also on very HC Dry food the entire time so I think the dosage was heavily inflated. That's the main reason I've been toying with the idea of bigger reductions than normal.

I got a little higher PMPS reading than AMPS but committed to 5 units and we'll how that goes this cycle.

Added the info to signature as well.

 

Yes. We actually reduced Fluffy’s dose by more than the SLGS protocol. We have reduced it by a full .5 units for now. Thanks, Diane.

 

Thanks Suzanne
@Suzanne & Darcy

 

A good cycle last night on the 5 units and I am glad to see the AMPS so similar to yesterday’s so we can see how things go with the 5 from that starting point.

 

Thanks for always watching out for so many people!

 

So far, it looks like we have found a good safe dose for Fluffy for the time being, at least. Do you feel confident about it for returning to work tomorrow?

 

I'm quite pleased with the numbers. Didn't get to test as much this cycle as the past two, but I tried to hit the key times based on the previous patterns. I'm feeling good about this dose while I'm at work though.

If I get a much lower preshot reading than usual before I leave for work I'll play it very safe and use a more conservative dose but I think what I'm seeing so far is encouraging.

 

He's on a mission!

Looking at the last reduction, I thought we might see green the 3rd cycle this reduction too!

How's he doing and feeling?

 

Haha no kidding. Little dude's got me working overtime. He seems to be doing really good though. He's not overly mobile quite yet but he's definitely getting around the place more than last week that's for sure.

He'll also start on zoballine with today's meal so hopefully that goes well. I may reduce today's AM dose a little while I go to work today just out of an abundance of caution. I'm encouraged by what I'm seeing though.

 

It hasn't been a week yet, until we're sure all HC dry has left his system and he's had time to settle in, to be safe, I'd reduce too. Let the numbers guide you.

Good to hear he's doing a bit better - that's what it's all about, it's not just about the numbers, sometimes we forget that.

 

@FluffyP

You've done fantastic these last 4-5 days. Your dedication to Fluffy shines through loud and clear! We know what the worry is like and what it's like to loose that kind of sleep. Please take the time to be good to yourself. You deserve it!

 

Fluffy! Go Fluffy! He wants another reduction If Fluffy were mine, I might cut the dose to 4.5 since I was not going to be home for the entire cycle. Of course, I don’t know what his preshot number will be yet, so I am only speculating if it’s similar to the last two days AMPS.

 

He ended up at 334 which is a little higher than the last couple of days, but for peace of mind since I'll be at work for the first time in a few days I'm gonna commit to just 4.5 to be safe, since he's shown me a couple times he can cut those numbers down pretty quick.

 

Had a family member go check on him and run a few tests. He didn't eat his snacks cause he wasn't paying attention to the automatic feeder. Ended up sub 90 again even on the 4.5 units, although that was without the LC snacks. Ended up having one at +5.5

Might take him a while to get used to the feeder but I'll try and encourage his curiosity with it. Might go down to 4 now? It seems like he's adamant on cutting into those greens regardless

 

He will get used to the feeder, I am sure. I definitely would reduce by another half unit down to 4 units! Awesome. So nice that your family could test! Fluffy must be a real sweetheart.

 

Just got home from work and wanted to do a test to make sure he was in the clear but he immediately began hissing at me even as I was getting close. I was able to do it but he was very very agitated.

He's always been the biggest sweetheart and never aggressive towards me. He's NEVER hissed at me before so this is really really concerning. He apparently was also hissing at my sister who came over for him and he's always had a positive relationship with him too, and he began hissing at my other cat which is strange too.

I feel like he's been a little more reclusive today than prior days. Maybe something else is wrong? I'm not sure how to feel about it all.

 

Jess had one of those days, hissed at me once, took me by surprise, I looked at her and laughed "Did you just hiss at me?" And she used to get so cranky when she was yellow, moan and groan about everything - I used to call it her 'Drama Queen Yellow Self!'

He may just be having a bad day, missing all the attention he's been getting lately and feeling a little off.

 

Why the full unit reduction last night - down to 3.5? Just wondering.

 

So last night I just hit my physical and mental limit. And his reaction last night to me wanting to test him just really broke me down. He's never displayed that kind of aggressive behavior towards me but it was clear he was just tired of being woken up multiple times throughout the night and poked. I told myself both me and him needed a full night's sleep and that I wouldn't wake either one of us up overnight to test so that we could both rest. That's why I ended up just doing a conservative 3.5

To be honest with everyone, the most important thing to me with fluffy is our bond. He's always been super close to me but last night was his way of telling me he was tired. I feel like if the frequent testing, especially overnight, is going to drain both of us and damage the bond between us then I have to reevaluate whether it's worth it. I really really do want the best of us but I have to consider what it'll cost us.

I hope everyone understands where I'm coming from, and I'm assuming y'all have been in my shoes with this so you know where my heads at. I just have lots to think about. So yeah I basically just wanted to be ultra conservative last nights cycle and this AM cycle since he wouldn't be tested much outside of his pre dose times. Maybe it's just a matter of us finding a nice middle ground and balance when it comes to the testing process., it just unfortunate that that comes with risks as well.

 

You'll see times/notes on my spreadsheet where I reduced and/or skipped shots when I needed sleep/had a bad headache or needed a break from whatever else was going on.

You NEED to take care of yourself so you can take care of Fluffy and your other kitty too.

 

I do understand. I was afraid that’s what it was. You have been testing a LOT at night and it does not look like you have been sleeping and waking up to get a test and go back to bed. It looks like you’ve just been staying up. That’s not good for you. You can’t keep it up indefinitely.

It is important to try to get at least one test for each cycle (which you can’t do in the a.m. cycle on workdays, I realize.) If you can get a +3 or something in the p.m. that would be great — or go to sleep and set one alarm to wake up and test at +5 or +6?

With regard to Fluffy’s behavior, there could be multiple things going on. I hope none of them are because he doesn’t feel well. If he’s in really high BG (like that black) that could make him feel terrible. I have definitely seen that in cats here. But also, the opposite can be true. When a cat isn’t used to being in normal glucose numbers, it’s not uncommon for them to feel really strange — some cats will actually hide themselves away. Some become lethargic. It can happen with normal BG (greens like yesterday) or high BG. Some cats don’t even like 200s or higher. Every cat is different in that respect. Also, be sure to give Fluffy a treat with every single BG test. You are probably already doing that. I understand about your bond with Fluffy. You don’t want to harm Fluffy by keeping him in BG that’s too high (especially above the kidney threshold) and you don’t want to upset him. It’s still very new for him and maybe he is having an adjustment period. How did he act otherwise— I mean after you left him alone last night? Or this morning? Does he seem normal? Appetite still good?

 

I think in the future it might be easiest to get one reading at pm +3 or pm +4, as I've always stayed up late in general because of my work schedule. I can also experiment with the +6 alarm on days when I want to sleep earlier. I guess the problem is this is all very new to me so seeing low blues and greens sets off panic alarms for me so I end up staying up to test multiple times. I think I need to find a way to find the balance for both of us.

With regards to his behavior after I left him alone he calmed down a lot, he still wasn't happy about the test before the pm dose but I think he pushed through cause he was looking Forward to his meal. His appetite is still very much intact. He ended up hanging out on the couch with me for a bit after he ate so I think the time to calm down helped.

This morning his demeanor seemed good as well. Once again came to hang around. I can tell he was getting annoyed during the testing process but he was patient enough to let me get the reading. I think overall I've noticed he becomes much more lethargic and almost reclusive around the nadir points. I think youre spot on that the unusual low numbers for him make him not feel very well or strange at least. He's normally much more active a few hours before and after feeding times.

 

It is totally understandable about being nervous when the blues and greens come. You always wonder if/when your cat will stop! The only real antidote for that is time and data - knowing your cat's patterns and just becoming more comfortable with the lower normal numbers that neither Fluffy nor you are used to at this time. One of our moderators talks about how her cat was lethargic and hid under the bed in green and was active and seemed happy in higher numbers. Some liken it to being used to drinking a lot of caffeine all the time and then having it taken away. I actually see it in a lot of people’s cats. @Shawn & Sir Maximus

 

As I recall @Shawn & Sir Maximus when we were first getting Sir Maximus into greens, he was lethargic and acted like he didn’t feel well.

 

In fact, @FluffyP you might want to take a look at Sir Maximus’ spreadsheet when you get a chance. He started out in high numbers and on a much larger dose than he is now. He was very bouncy as well. I think that sometimes Shawn was about to pull his hair out. But now look as his numbers on only .25 units. I am really proud of that.

 

Ohhh I'll take a look at that. Honestly I feel confident that we're on the right track with dosages. I just want to make sure I can do it in a way that preserves his overall quality of life.

I ended up going 3.5 again today cause I'm not sure anyone can test today while I'm at work or if he'd allow someone else to do it. And he also hasn't grasped the feeder despite some efforts, so without the snack I wanted to play it a little safe. The other cat likes to steal it if she notices it before him .

 

Oh. I didn’t realize there was another cat in the mix! That complicates snacks. Some people use one of those microchip feeders for that.

Be sure to give him something like a Pure Bites freeze dried piece of chicken breast or similar treat with every single test - even if you fail to draw blood or if he growls or hisses.

 

https://docs.google.com/spreadsheet...X5fH86twjISK-BDQhv_B7J-s2gpeXeOmSTELX/pubhtml


Here’s Sir Maximus’ spreadsheet. Be sure to look at the 2023 tab to see where they started.

 

Normally he's very on top of the food business and wastes no time when there's wet food out. The other cat, Eve, has never been one to fight him over food. If he wants the food she'll let him have it. She's much smaller and doesn't want to put up a fight over it. Only problem right now is that he's just not aware of the snacks at all so if an hour or two passes and she sees it sitting there she'll grab it.

I have a camera inside where I can see them and the +2 snack has been sitting on the feeder for a good hour since he's been sleeping in the other other room under the bed. Eve may have noticed it but hasn't Even gone to check it out.

 

Yes there were many many nights i went to bed wondering if I was ever going to get him regulated into good numbers. It was very aggravating going thru all the stages of his bouncing but i said to myself keep fighting for him and do everything you can and there will come a day he will become healthy and see good numbers. Thankfully will all of Suzanne's guidance and members on this forum he is regulated. Hopefully one day i can get him into remission!

When you start seeing those greens and blues don't be afraid of those numbers and embrace them. You can look back at Fluffy's chart and see his patterns and this will start to ease your mind when he gets down into those low numbers. I have many posts where Suzanne and i have went step by step on how to manage low numbers all the way down into the low 50's. When he was bouncing a lot he would sleep constantly as expected because he didn't feel good going from the highs and lows. It will take time and a lot of dedication but you will get Fluffy regulated soon just take it day by day and do the best you can for him. Good luck and stay positive and feel free to private message me if you have any questions....

 

Yeah I think this is the most important part for me. My fear of those low numbers can be overwhelming sometimes. I really really am trying to do my best to stay positive but hearing stories and experiences like yours makes it easier to feel like there's light at the end of the tunnel.

 

Last night was a bit strange, I know it's hard to pick up and identify patterns when I can't really test during work days but I was so surprised to see a blue PMPS number. Once again I tried to be conservative with my dose and did 3 units. He stayed so flat in his 2 overnight tests that I'm questioning whether that PMPS reading was an error?

Sometimes I feel like I'm being reckless lowering dose constantly but I'm always trying to give te safest dose while trying to maintain a level of efficiency. Everytime I've lowered though it seems like his BG numbers have responded well, but it's hard for me to interpret the numbers all the time.

Does anyone have any suggestions on ways i can help heal his ears? I feel like one of the primary reasons he's fighting the testing process now is that his ears may be a little sore and that's causing him to lash out. He's a white cat so its easy to see all my marks on his ears so it may exacerbate the issues but anything I can do to help make the testing process easier will go a long way i think.

 

Hi. About the unexpectedly low PMPS reading, we need to talk about meter variance. These glucose meters are allowed to have up to a +/- 20/25 percent variance, which means that the 192 PMPS you had last night is not much different than the 223 that you had two nights before (and you shot 5 units that night and he did well.). You can sometimes test the same drop of blood and get a value that is 20 percent higher or lower — but sometimes you will get something very similar. The time that we really need to just take the meter at face value is when we are dealing with greens. If ever getting a BG test that is unexpected, it’s a good idea to retest. I realize that right now he’s been grumpy about it though so do what you can.

 

According to SLGS protocol, right now, Fluffy’s dose should be 4.25 after the last reduction he earned on May 23 when he received 4.5 units and dropped just below 90. I don’t really think it’s in his best interest to keep chopping and changing the dose quite this much, but I get it. When will you have a few days off again to o get some daytime tests done if he will allow it?

 

I will be off the next three days. I'm confident I can get at least pre shot readings and a +5 or +6 reading since that seems to be his nadir. I was able to pretty easily get the +4 and +6 readings overnight. He was so sleepy I dont think he had the energy to really fight me about it, and I was able to do it quick enough that we were both able to go back to bed. I'll go back up to 4 units tonight? Do you think that's a good idea?

 

Do you alternate between both ears? Do you move slightly up and down the edge area of the ear that is outside the marginal vein so that you aren’t hitting the same spot? What size lancets are you using. If his ears usually give blood and you are pretty good at testing, you can move to a tinier lancet. I used 30 gauge ultra thin lancets. You aren’t using the lancing device are you? I always just did it free hand to have more control. Also, go in at about a 45 degree angle. Some people put a little pure coconut oil on their cat’s ears. I would try Colloidal Silver gel like Silverquine
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Yes. I would think it’s okay to try 4 units. And maybe you will be able to direct his attention to the automatic feeder, too

 

Yes, I'm alternating as much as possible and I try and move the spots as best as possible. I always aim for that outer portion, I'd say most of the time i get it pretty good but I have missed on occasion and gone closer to the vein than I'd have liked. I usually get pretty good blood amounts as long as I can warm them up well. I've been using the sock with rice but he's starting to hate that part the most.

I use the 28 gauge lancing device that comes with the Alphatrack. I'm not sure I feel comfortable doing it free hand, makes me a little nervous and a bit outside my comfort zone at this time to be honest.

I'll try coconut oil and order that gel as well, see which seems to help the most. Would I apply after each test or maybe just a couple times a day?

 

I would just put it on a couple of times a day. Some cats absolutely hate the lancing device because of the sound it makes — it can be startling.

 

The 28 gauge is thicker than the 30s I used, but when I first started I used a larger size. I bought the ReliOn ultra thin lancets for “sensitive fingers.”

 

Surprisingly enough the click has never been too startling for him and I've tried to associate the sound of the click with a treat. What seems to bother him most is the warming of the ears, especially when I apply pressure with the warm sock, and then when I try to massage a little extra blood out after the pricking of the ear. That's why I'm thinking maybe he's sore in that general area. Just overall me "handling" the ear seems to be what bothers him.

 

We sometimes see a flat cycle when kitty is getting ready to clear a bounce - wondering if that's what we're seeing with that flat blue cycle last night.

I wouldn't jump back up to 4 units. I might try the 3.5 units again at the most, as long as you can monitor. Those are fantastic numbers for basically "just starting out" (from the no HC dry point only a week ago).

I know your circumstances are a little different, but, so, I'm also looking at - we raise a dose by 0.5 units if we're seeing nadirs above 200 (if following MPM and in certain circumstances following SLGS) We know 3.0 units brought him into blue. We know he ended the 3.5 unit cycle in blue but don't know what happened at nadir - if that 3.5 units brought him between 90 and 150 at nadir the SLGS protocol recommends hold the dose. We don't know what happened at nadir and why I'd be reluctant to go back to 4.0 units just yet.

 

Ok, that explanation makes sense to me. Abundance of caution has always been the name of the game for me here. Obviously his change in demeanor towards testing has complicated issues a bit, but I think I'm on board with 3.5 over the next few days and seeing what that looks like unless anyone has any objections?

I also started the zobaline two days ago. I break apart one pill over his morning meal per day. I've seen some people say they do two pills a day? Any thoughts on that as well. His neuropathy is probably the thing I'm most desperate to see remedied, at least to some extent. I know it wont happen overnight though.

 

Feline Diabetic Neuropathy
"The usual dose is between 3 and 5mg (3000 - 5000 mcg) per day, regardless of weight or body size. Methyl B12 is water soluble, so any excess is excreted in the urine- no worries about overdosing."

 

Just an update, at PMPS feeding Fluffy did not want to go near his food. This is highly unusual for him as he ALWAYS has an appetite. I got pretty scared at the sudden loss of appetite. I tried mixing in approximately 1 teaspoon of HC wet food and he began to eat, but then threw up right after. After he threw up he began to eat the rest of the meal normally. I only did 3 units instead of the 3.5 because of the uncertainty of whether or not he would keep his food down. I'll monitor over the next few hours, as of now he has kept it down. In the morning I'll go buy a different flavor of LC wet and see if maybe he was just tired of the chicken flavor.

Edit: ate his snack at +4 and had a very large bowl movement.

 

Tested at a 158 at AMPS. Would y'all recommend shooting at all ? @Suzanne & Darcy @Shelley & Jess

 

This is that grey area shooting low for the first time and he's been in such a hurry to lower that dose! Do you want to start with a token dose of 1 unit to see how he does?

 

Do you think a .5 unit is too little?

He's been on 3 units so I'm just trying to look at that 10-25% number on the dosing guide