Help! Dosing advice for Fatty (repost from PZ forum)

Hello you smart and experienced people,

I had a previous thread here (https://felinediabetes.com/FDMB/threads/advice-please-bounce.242619/) but am starting a new one ... hope that's okay.

The long and the short is that Fatty (CKD, diabetes, pancreatitis) switched to a new high carb (Hill's, 40%) renal food January 18, having previously been regulated on a lower carb renal food (Royal Canin, 22%) on 1.0 U Prozinc BID. His numbers, not surprisingly, went through the roof.

I've been transitioning him back to the Royal Canin since Tuesday. His numbers are looking way better so far, but now I don't know how much insulin to give him. I've read the dosing sticky and while he's above the 200 cut off for not giving a shot for new diagnoses (he's not newly diagnosed, but may as well be, as I didn't have much data until very recently and this new food mess made me realize how easy I had it before). Being on 2.5U and eating more of the lower carb food, I don't know how much to give him tonight. On this Royal Canin, he was so responsive to insulin so I don't want to overdose him, but when I tried to reduce his dose on the Hill's last week, he was HI for most of the day and I do not want that to happen either.

Our spreadsheet is linked in my signature. Thank you!

update: 220 (12.2) @ PMPS; 229 (12.7) @ +1 after PMPS and +0.5 after meal

 

Well that was quite the drop today!

As an FYI, when you stall it needs to be without food. We need to be able to see if his numbers are going up, down, or staying flat without the food.

Would you be able to update the Remarks column to mention the amounts and %s of the food he's been getting since you started transitioning? For example, if today his food was half 40% food and half 22% food that helps to know. Along with the time(s) he ate if you know that.

The high carb food can influence numbers so much, plus the feeding while stalling, it's a bit hard to give advice here. I would not give the full dose, nor would I skip. I'd be looking in the 0.5U-1.25U range...but I can't stay up with you, so unfortunately has to be your call.

I expect a food bump at +2 and +3...or even a possible bounce from the blues today. It's the +4 and later that I'd expect to be a bit more eventful.

 

I just saw your post in the PZ forum was 2 hrs ago. Just an FYI your schedule will be a little off if you do decide to shoot.

 

Thanks so much for your response!

I read the withholding food during the stall right after I fed him ... oops. I just rechecked and 1.5hr after meal, his BG is up to 15.2.

I have the "+however many hours" since meal in the Remarks column, but will do better at noting the percentages of each kind of food.

I guess I'll try 1.0U? That worked for him before when he was on 100% Royal Canin (though that doesn't mean it will work for him now) and will continue to monitor.

What an exciting little dude

 

No big harm since his numbers leave you a little padding. The PZ duration is usually 10-14 hrs in cats, so the reason we stall without food is so we can see if the insulin has worn off and he's coming back up, or maybe it's still working and we need to be careful.

Thanks! The percentages help because one food is basically double the carbs (or something like that, it's late ), so it helps to pinpoint how many carbs he's actually getting. I'm also hoping there will be a correlation between that and the BGs, so it's a bit easier to "predict" what his BGs will do and get a better feel for dosing .

The fun never ends!

 

Yes! And I have to remind myself not to get too excited that he's taking to the transition so far, and that I have to make sure his insulin dose isn't attached to the Hill's food.

Thank you for your support -- sleep tight and stay tuned ...

 

Aaand that looks like a bounce. Could be food but not sure.

If he is bouncing my guess is he'll be high and somewhat flat today, then come down around PMPS (based on history).

 

Ah yes, back into the pink and red ... sigh. I guess you can't answer this since we're still 3.5h from AMPS with this wacky new schedule, but would I stick with the 1.0, not the 2.5?

 

He seems to break bounces pretty quickly, hoping for an AMPS in the 300 range.

Not sure what your plan is for food today...if keeping the 50/50 split and AMPS above 275 or so I think 2.5U is fine. His body probably just has to get used to these lower numbers. If you're reducing the amount of higher carb food again today, I'd consider maybe a 0.25-0.5U reduction.

I'm getting a little out of my depth here with the bouncing and food changes. Normally it's best to hold the same dose through bounces, but the food makes things a bit difficult. Going to tag @Deb & Wink for better guidance.

 

I was planning on reducing the higher carb food a bit but will hold off on that if it's easier on his little body -- he has been through a lot lately so while I am keen to have him back on the lower carb food, slow and steady is not the enemy here, especially if it cuts down on bounces (and it's Friday again -- the time of the week when weird stuff happens!)

I'll see where we're at in an hour and go from there.

Thank you again!

 

So true.


Mogs
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Well, BGs haven't moved much: +6.25 last night was 22.4, +10 was 22.8, AMPS just now was 22.7. I just checked my own to make sure my meter wasn't stuck!

 

Ok. At this point all I can say is I would not skip the shot. I suspect he may break the bounce in this cycle or towards PM.

Here's my thought process, do with it what you will: he's bouncing almost every other day. To me, that indicates a lower dose might be better, so you can more slowly bring him down over time. Looking at the data you do have, 1U seems to be too low to hold him in lower numbers...they just continue to climb.

If it were my cat, and this is not dose advice and would be purely experimental on my part, I'd try something like 1.5U or 1.75U for a few cycles with close monitoring....even if he throws you the random 200 PS numbers. The bouncing + food changes + dose changes make it a bit hard to see the trees from the forest, which is why I'd be trying something more consistent.

You know Fatty best and seem to be getting a good handle on FD. I'd just make the most educated decision you can and wait for Deb to pop in

 

Thank you! I just read this right after giving him his shot (of course) -- I went with 2.25, blergh. I do think all the changes are making it hard to see what's going on, especially because I'm such a newb.

I will continue to monitor today and maybe try with 1.75 tonight for a few cycles to see how he does with more consistency.

 

I don't think there's any harm in that as long as you can keep an eye out...but it might result in another bounce lol we'll see!

As much as we try to make FD a science here, there's also an art to it and sometimes you just have to try stuff to see what happens.

 

Oh Fats. He's so patient with all my thrashing around ...

 

That's what I used to call my first boy for short. (Full name was Psycho Fatboy the Third. No, he wasn't a pedigree cat.)


Mogs
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I am dead hahaha sounds like how we name animals over here too!

 

Hahaha. Nothing but the classiest names for the loves of our lives! Moggie was the name of my mom's cat.

 

And, if we're being formal, it's SIR Fats.

 

Consider me well and truly told.


Mogs
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I do think that SIR Fats is bouncing from those low blues the other day.
With the multiple health issues, including the kidney disease, and the need for some higher carb kidney disease specific food, you'll likely see higher BG levels.
If so, you simply adjust the insulin dose to accommodate the other health issues.
So if Fatty needs more insulin, he needs more insulin. So be it.

Yes, it's harder to see what is going on if you are making multiple changes at the same time. Difficult to pinpoint if the change in dose or the change in diet was the decisive factor. Or maybe he's just clearing a bounce!

But sometimes you have to change multiple factors at the same time. So don't worry too much about it.

 

Thanks Deb! He was so good on the Royal Canin before and he already seems to be dropping with the food transition so I'm hoping we can get him back to a good place where he feels his damn finest.

Our vet just called and also recommended trying 1.5 or 1.75 for a few cycles to see how he does -- Melissa, just as you suggested!

 

I better turn my crystal ball off before it fries lol

Really though as long as you're doing things slowly and thoughtfully and monitoring, you can't go too far wrong. You just have to play around a bit to find a balance. Good luck tonight!

 

Thank you all for your kind (and funny) and helpful words! 1.75U tonight ... here's hoping that suits him fine.

 

That's a nice +3! No bounce, no bounce, no bounce

 

It is, isn't it! A tiny part of me is like ... "Damn, how nice to not see any black cells for a few days!" but the day is young ...

 

Anti-jinx!


Mogs
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Thank you for your anti-jinx protection! So far we've had a pretty pleasant run.

 

Let's give Sir Fats a couple more cycles on that reduced dose to see how he does. But I think you may need to increase the dose again soon.

 

Thanks Deb! I slowed down the food transition to try and see how he’d do on this lower dose but I will try to do a 75/25 split (lower carb/higher carb) starting tomorrow morning to see if 1) he’ll eat it happily and 2) the dose suits him better. He seems much brighter and like he’s feeling way better even with this slight improvement in his BG!

 

Oh gosh. Throwing me with this PMPS 229/12.7 ... I gave him 1.5 as 1.0 seemed to be not enough last time his PMPS was 220/12.2. I will check again beginning at +2.

 

Well that looks pretty good, at least in comparison to the reds and blacks! Looks like you could have gone full dose, high carb food still keeping him higher.

I'd keep him around 1.75U for the next few cycles just to give him time to adjust. If he stays in these yellows and pinks, then can up it to 2U and hopefully he won't bounce again

 

Thank you! I got nervous last night after his shot (and slept through one of my BG check alarms, but it was fine) ... gave him a few dry kibbles that he loves but that wasn't necessary. Back to 1.75 this morning and we'll see how he does! I tried to give him more of the lower carb and less of the higher carb a few times but he doesn't seem to eat it as well, so perhaps the best thing is to just go back up a bit and keep him with the 50/50 food split if his numbers do okay with a higher dose and no bouncing.

 

Okay, what in the @#$% ?!?!? +5.25 was 203 or 11.3, +7 was 266 or 14.8, PMPS was ..... 571 or 31.7. Is he sneaking ice cream? Cupcakes? Sugar cubes? Well, it was a nice 5 days of no blacks.

 

I think I would actually increase Fatty's dose. Back to 2U. That 1.75U dose isn't getting him into the blues/greens.

I know you are still working on the food transition. So please continue to do your great BG monitoring job with him.

 

Thank you! I was reading the dosing sticky a few minutes ago and thinking the same thing. I'm not sure if Fats will go for the full diet transition -- we seem to be stalled at 50/50, so it seems easier for everyone to try bumping the dose up instead of trying to make him eat something he doesn't want to eat happily. 2.0, here we come ... fingers crossed it doesn't do anything wonky!

 

Hopefully he's a little more used to yellows and pinks and the increase works!

 

Wink was a dry food addict. Founding member, president and spokescat for DFAA (Dry Food Addicts Anonymous).
I used every one of these tips and tricks to get him to realize that wet food was edible.
https://catinfo.org/docs/TipsForTransitioning1-14-11.pdf

 

I will be hoping AND praying AND making wishes! He's been pretty pink all day today but at least the black last night didn't stick around for too long ... it could be back though. You never know these days.

This is such a great resource! Fats has actually been on canned food since he got diagnosed with diabetes, and I just got a bag of dry renal food last month in a moment of extreme weakness. Sometimes I give him a few pieces on top of his food to entice him to eat, which I know is bad ... interesting reading that piece because something in the dry food makes him go totally completely bonkers for it. Perhaps I'll look into FortiFlora in case that has the same effect. The food I'm trying to switch him over to is canned renal food that he ate quite happily from end of September to end of December, and I'm not sure if he's kind of over it because he was feeling so sick with pancreatitis starting early Jan, or what. The new renal canned food he has been on since mid Jan (the one I'm trying to get him off of) is also fishy and Fats is certainly a man of refined tastes, as in ... he loves fish everything. I have been reading up on the bad stuff about fishy food so that's another reason to get him off of it, but so far 50/50 seems to be where we're stalling. I will channel my inner Dr. Lisa and be patient ...

 

... I'm tired. I'm really tired. I will start with 2.0 tomorrow morning but going to stick to 1.75 tonight (PMPS 371 or 20.6, so probably totally fine at 2.0) so I don't have to get up every 2 hours to check. When I stalled a few days ago our schedule got pushed back into the wee hours.

 

It's like having a newborn baby some days for sure.

He's not seen any dangerously low numbers, or even close to it (not that it can't happen, just unlikely). So I wouldn't worry too much.

Some people religiously get up to check....I am not one of them, not at these numbers anyway. I know the +3 is a good indicator for Mr Kitty, and seems to be for you too. If the +3 is flat or within meter variance, I don't get up to check again. If it's showing a decent drop, then I'll do a +5-ish and go from there. If +5 is not a very big drop or close to green, back to bed til morning!

 

That's so helpful, thank you!

I think my brain is lagging behind Fatty's new normal -- before even 1.0 seemed like a lot (different food though), so anything above that dose freaks me out even though the numbers have all been pretty high. Before everything went sideways last month, his nadirs were usually 4-6 and that didn't bother me at all, but even those two blue numbers last week or whenever were enough to make me be like "OKAY, DO I HAVE THE HONEY READY?" Just gave him 2.0 ...

 

You could skip a dose, if that is easier to get you back to your normal dosing schedule (and much needed sleep).
Think of a "skipped" shot is being like a fur shot, where you don't think you got the insulin into your cat.

Other ideas, which are in the dosing protocol document.
Don't stall for more than 1 hour with Prozinc. You'll still be able to stick to your normal schedule.
Do a token dose (10-25% of the normal dose) instead, if the numbers are lower than expected at pre-shot. Under 150 for example.
Walk back the dosing time by 30 minutes to 1 hour per day, to get back to your normal time. Prozinc is more forgiving of time changes.
Try to shoot a BG that is close to 200. Say in the 190 to 230 range. Those blues at nadir aren't particularly low, in the greens would be good at nadir and still safe. You need to pay more attention when the drop is earlier in the cycle and is in the lower tree green or neon green range.

Dry food has "animal digest" sprayed on it. Pretty gross how they make that product.

Try crushing a couple of pieces of a freeze dried treat, like Halo Liv-a-little chicken or Pure Bites chicken treats and sprinkling that on top of the wet food to get Fatty to eat more of the wet. It was one of my best tricks to get Wink to eat the wet food. Of course, I'd have to sprinkle that "topper" on his food portion 3-4 times to get him to eat his serving.

 

Oh, so it's not just me who has that problem! I feel somewhat reassured.


Mogs
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My fellow treat-crushers! Fatty gets a piece of Pure Bites minnow after I test his BG ... his poor ears are looking kind of pink around the edges.

I'm hesitant to skip a dose when his BG has been so high lately ... I will try walking it back by 30-60 mins until we are at a more civilized dosing time. Currently at 1am/1pm, so not the best, but I can deal with it for a bit. Thank you for that info!

How long does it usually take to see the effects of a dose increase? A few cycles? So far his BGs today have been high 300s/low 400s. I am trying not to be disheartened. He doesn't seem to have bounced ............. yet ............. (please no bounce please no bounce) so that's a positive!

 

<... ceremonially pours out libation for the Kitty Gods...>


Mogs
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Usually 3 days or so? But since there's still high carb maybe more like 5 days? I'm really not sure unfortunately

 

Hahaha. All hail!

So suspenseful ... I guess we shall see! His PMPS was lower than his +6, oddly. What a mystery man!

 

What in the ! +3 last night was red, AMPS this morning was black. Oh yellows, come back to me ...

 

('nuff said.)


Mogs
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Se. Ri. Ous. Ly. !!!!! At least +5 is moving in the right direction ... in the meantime, we'll be in the tub, drinking from the tap and musing on the mysteries of proper dosing ...

 

At least you have running water, unlike so many people in Texas.

 

So true! Blessed to have enough water for both of us. Are you in Texas? Either way, hope you are staying safe and well!

 

Looks to me like Sir Fats will need another dose increase soon. Maybe in a couple more cycles. Not seeing any blues for him since 2/11/21 (11/2/21 in your date format) when you reduced the dose.

In the northeast, in Massachusetts, where we are getting another round of the frozen stuff (snow) over the next 2 days.

 

Ah yes -- I am in southern Ontario and we seem to be getting more snow within the past two weeks than we've had in years!

I'm not sure if this counts as a bounce or not, but yesterday AM when I increased is dose to 2.0, he went into the reds and then into the blacks this morning. His +8.25 was better (227 or 12.6) so I'm hoping he just needs a bit of time to settle down before doing another dose increase. There must be a dose that works him ... right?

 

So what did the vet think about how Fatty is doing?

 

So kind of you to ask, thank you!

We will have to wait until Monday for his labs because they are going out of house, but the vet said he looks great and his weight is stable, so those are good things.

She checked his BG at +11 and it was freaking 11.something, so low 200s, way lower than it was. And at the vet, which is possibly stressful (though she said he was cool as a cucumber)? HUH? She said I could drop his dose down to 1.5U given that reading, but by the time I got home and checked again, it was up a bit more. And whenever I drop his dose he goes way higher, so I forged ahead with 2.0 and at +7, it hasn't dropped him down too much, but at least we're in the yellows for now.

 

Well folks, I am profoundly confused.

I'm inclined to keep him at 2.0U for the next two days (for a total of 5 days, 10 cycles) to see if anything settles. Looking back through his spreadsheet, I see that his current 6-cycle dose at 2.0 is the longest I've held anything, and the first few seem to be all over the place after an adjustment up or down, so maybe this is worth a shot.

The high "nadirs" (if we can call them that) seem to warrant a dose increase, but looking back, it almost looks like his nadirs were lower on 1.75U (though still high).

 

Might be a good idea. He may just be a very bouncy cat, and holding the dose a bit longer helps get him used to lower numbers? Or it really is the food throwing everything out if whack, though if it's consistent amounts/ratios/times that's a bit surprising to me

 

Even if I would have a more clear indication of how to adjust the dose after two more days, I'd take that as a win. I'm blending his food (one 5.5oz can high carb to two 3oz cans lower carb) to make sure it's the exact same every time, but his spreadsheet still looks confusing as heck to me!

 

Spreadsheets are confusing.
You don't want to focus too much on only 1 or 2 cycles.
You want to look for trends or patterns.

 

OMG A MOTHERFLIPPIN BLUE!!!! I am organizing a parade in Fatty's honour!

 

We'll join your parade, in honor of Fatty.

 

I, for one, welcome our new feline overlord.




Mogs
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Hahaha. Obviously you will all have your own floats and marching bands as tokens of our gratitude for your ongoing guidance and hilariousness!

 

... a green. We got a green. This prayer hasn't worked in the past but: please no bounce please no bounce

 

Whoa!

 

I second, third, and fourth that.

 

@FrostD - Boy or girl?


Mogs
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Boy! 7 lb 10 oz, 20"

Water broke 6:30a, no contractions. Born 11:30a in about 5 pushes, no pain meds was a wild morning!

 

@FrostD -

You certainly don't mess around, Melissa! Hope mama and baby boy are both doing great.




Mogs
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Congratulations! Hoping your new baby boy is just as cute as your fur baby — I have no doubts

 

Wondering ... I’ve been trying so damn hard to figure out Sir Fatty’s BG for weeks now, as you are well aware. What do you think of this plan:

What if, instead of trying to do a slow transition between foods while also trying to navigate his dosing (the drop still has me freaked, and the HIs do too), I try to do a full reset and try (beg, plead, pray) to give him only the lower carb renal food? He ate a few pieces quite happily this morning. It’s the same kind he was on in the fall at 1.0U but they’ve done a tiny formula tweak, so maybe that’s enough of a change for him. I would give no insulin for maybe a day to see if he would take to it, then add insulin back in? Is that crazy? I’m at a loss here.

Hopefully our vet will call tonight but while she is excellent with kidney stuff, I feel like you wonderful wondrous wonders know more about dosing.

If this is dumb/risky, please — don’t hold back!

 

Is he stage 4 ckd? If not you can just feed a low carb low phosphorus food.

 

Hi again Janet, he's early stage 3 (values were almost up to stage 4 a month ago, so I'm still on eggshells). I made a note of the Weruva foods you mentioned on another post of mine a few weeks' back, but I still haven't been able to find them. Now that some pet stores near me are opening up again I will go and try to track down a few kinds in person.

May I ask, if I were to try one of these low carb foods, would you suggest withholding insulin for a day/a few days? He seems to be super sensitive to carbs and I don't want to overdose him (again).

 

It sounds like Sir Fatty is the one you have to beg, plead, pray with to get him to eat only the lower renal food. It's really up to him if your proposed plan would work. Go ahead and try it. If it doesn't work, you go back to how you were doing the food transition before.

Life is not without risks Alana.

The risk with stopping insulin altogether, would be from the formation of ketones, especially if Sir Fatty isn't eating enough. That would be my main concern, him not eating enough.

Ketones form when there is not enough food and/or not enough insulin and/or there is an infection/inflammation of some kind. The cat burns up there own fat and then muscle tissue, and that produces the toxic byproduct of ketones.

You already tested him for ketones yesterday. So try for a ketone test every day.

 

Thank you Deb!

Yes, all of this is entirely up to Fats -- like everything else, really! Thanks for your clear explanation on the ketones. I will keep an eye on them and his food consumption and see how we do!

 

Reds and blacks ... poor Fats. Considering giving him 1.0U tonight as the PZ dosing sticky recommends that as the starting dose if not on a low carb wet food diet and the new renal food is still 20% carbs. He was on 1.0U with this food before but it didn't have the higher carb "topper."

 

For some reason I didn't see this reply earlier this week... Sorry for the delay. I get weruva through chewy.com, but some pet stores sell them. Are you in the United States?
In your case I might not reduce the dose since he's still high.... Just keep a close eye.