New (continued) Monica & Mia

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MonicaT said:
@JL and Chip Is there a number for the preshot BG where you would think I should go back to 0.25u? Or should I stick with 0.1u even if she goes up to 10-15?
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I’m admittedly a bit cautious with dosing in general, but especially so with Mia given the recent very low numbers she was hitting on Caninsulin.

Questions:
- was Mia showing any symptoms of hypoglycemia when she dropped into the lime green numbers?

- your glucometer is a human meter (not a pet meter), correct?

- how is Mia acting? How is her appetite?

- have you succeeded in getting a recent ketone test?

- will you be able to continue testing frequently?

- are you comfortable dealing with the lime greens and intervening with food, etc (or does it stress you out)?

As Suzanne said, let’s see what Mia’s PMPS is. I could make an argument both ways re: 0.1u and 0.25u (although I probably lean toward the 0.1u for now).

Ideally we pick a dose we can stick with for a few days until the depot fills, after which is when you see the true effect of a dose. Mia went to 23 (1.3) less than 48 hours ago on Caninsulin and had a series of lime greens before that, so there’s a nagging question in the back of my mind as to whether we might also be seeing a bit of residual “bouncing” in the BG numbers (don’t worry too much about understanding that for now—it might not be relevant but @Suzanne & Darcy and @Bron and Sheba (GA) will know what I’m getting at). I also wonder how “taxed” the liver might be.

Given you haven’t had a chance to review and choose a dosing option (completely understandable), I tend to lean more conservative on dosing as well.

I think some of the answers to the above questions will nudge us one way or another. I also like to work the dose up from below rather than down from above, so I have an admitted bias. The difference between 0.1u and 0.25u is tiny so we’re probably splitting hairs here. :)
 
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Suzanne & Darcy said:
So I was just thinking I should explain. With her very small dose and her numbers, you are already in the position of following TR (instead of SLGS) because with SLGS a reduction is earned when the cat drops below 90. That would not be good for Mia right now when it looks like she may have a good possibility of going into remission. For example, she would have earned a reduction today with the 85 at +4. That would not help her to stay in the “healing green” numbers, as we like to call them around here. So with Tight Regulation (TR) protocol, we like to see lower numbers but keep the cat at 50 or above — mostly green or very low blues is good (hopefully under 120.)
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@Diane Tyler's Mom GA she wrote this earlier, so seems like I am following TR protocol
 
Okay. So just to sum up because we have talked about so many different scenarios and possibilities:

0.1 is her new dose. We will hold this dose and only adjust it up or down based on TR protocol. If Mia goes below 50 she will earn a reduction down to a drop dose. If, after a week at this dose (having allowed her small depot to build and we feel we are seeing the full effect of this dose) it looks like she needs an increase to .25 then she can receive the increase. I hope she won’t even need it once she settles into this dose. This makes it sound so simple bit cats don’t always make things so cut and dry — but these are just the basics. Of course, if anything changes about her appetite or your ability to monitor her cycles we would need to take that into consideration.
 
Suzanne & Darcy said:
And did you count the drops in your dose? It should be more than one drop.
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Suzanne & Darcy said:
Okay. So just to sum up because we have talked about so many different scenarios and possibilities:

0.1 is her new dose. We will hold this dose and only adjust it up or down based on TR protocol. If Mia goes below 50 she will earn a reduction down to a drop dose. If, after a week at this dose (having allowed her small depot to build and we feel we are seeing the full effect of this dose) it looks like she needs an increase to .25 then she can receive the increase. I hope she won’t even need it once she settles into this dose. This makes it sound so simple bit cats don’t always make things so cut and dry — but these are just the basics. Of course, if anything changes about her appetite or your ability to monitor her cycles we would need to take that into consideration.
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Thank you for this!! Will keep on following this going forward and keep testing and keep the SS updated.

I will test this evening with a syringe with water to get used to the amount and make sure she is always getting the same dose
 
JL and Chip said:
I’m admittedly a bit cautious with dosing in general, but especially so with Mia given the recent very low numbers she was hitting on Caninsulin.

Questions:
- was Mia showing any symptoms of hypoglycemia when she dropped into the lime green numbers?

- your glucometer is a human meter (not a pet meter), correct?

- how is Mia acting? How is her appetite?

- have you succeeded in getting a recent ketone test?

- will you be able to continue testing frequently?

- are you comfortable dealing with the lime greens and intervening with food, etc (or does it stress you out)?

As Suzanne said, let’s see what Mia’s PMPS is. I could make an argument both ways re: 0.1u and 0.25u (although I probably lean toward the 0.1u for now).

Ideally we pick a dose we can stick with for a few days until the depot fills, after which is when you see the true effect of a dose. Mia went to 23 (1.3) less than 48 hours ago on Caninsulin and had a series of lime greens before that, so there’s a nagging question in the back of my mind as to whether we might also be seeing a bit of residual “bouncing” in the BG numbers (don’t worry too much about understanding that for now—it might not be relevant but @Suzanne & Darcy and @Bron and Sheba (GA) will know what I’m getting at). I also wonder how “taxed” the liver might be.

Given you haven’t had a chance to review and choose a dosing option (completely understandable), I tend to lean more conservative on dosing as well.

I think some of the answers to the above questions will nudge us one way or another. I also like to work the dose up from below rather than down from above, so I have an admitted bias. The difference between 0.1u and 0.25u is tiny so we’re probably splitting hairs here. :)
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@JL and Chip
Only symptoms I saw only some of the times she was in lime green numbers is that she was a little more sleepy. But still alert, still running around, eating etc.

Glucometer is human

Mia is back to her normal self, playful, cleaning herself, cuddly with both us and our other cat, and has a good appetite

Still haven't been able to get a new ketone test, she is being sneaky with her litter times

I have gotten quite used to the lime green numbers and treating them. Of course it does stress me out a little, but mostly because I imagine it's exhausting for Mia going so low and back up again all the time.
 
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@MonicaT
Ok so if you are going to follow TR can you please add that to your signature and your spreadsheet on the US tab and the World Tab up top so members know so they don't have to keep asking you

@MonicaT
 
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@MonicaT
I was able to count the drops
I just went by this for Lantus Are the syringes you are using have the half unit markings?
upload_2024-10-26_14-34-22.jpeg



  • Full and half-unit syringe scales:
49823063143_3437e9e997_o.jpg

  • Don't reuse syringes. You'll not only run the risk of contaminating the vial/cartridge/pen, but re-using a syringe may be very uncomfortable for your cat:
 

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MonicaT said:
@Suzanne & Darcy having a little trouble measuring the drops as sometimes they come out as several small and sometimes one bigger one. When testing should I be pointing the syringe up or down?
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I’m not sure. I would think you would hold the syringe kind of horizontally to pointing slightly upward? Whatever you do, just do it the same every time. Don’t stress out about it. If it’s not working then we will just count on you to do your best to draw it the same way each time. :bighug: I am thinking that one bog drop is approximately equivalent to two smaller ones. It’s okay. You tried. Don’t wear yourself out over it. :bighug:
 
Diane Tyler's Mom GA said:
@MonicaT
I was able to count the drops
I just went by this for Lantus Are the syringes you are using have the half unit markings?
View attachment 71283


  • Full and half-unit syringe scales:
49823063143_3437e9e997_o.jpg

  • Don't reuse syringes. You'll not only run the risk of contaminating the vial/cartridge/pen, but re-using a syringe may be very uncomfortable for your cat:
Click to expand...
Yep. She has the photo and she has the correct syringes with half unit markings. Good thing you exchanged those other large syringes for the .3 mL size ones @MonicaT ! It would have been impossible to measure!
 
Hi Mónica,
I see you're in Malta, like us (Spain) clocks will be going back an hour. ( Heads up @Suzanne & Darcy @Bron and Sheba (GA))
Unlike our USA friends where it's next week.

When it comes to Mia's shot time it should be 12 hours after pmps so If you shot at 7pm tonight, tomorrow morning you would need to shoot at 6am be side of the clock change.

To adjust your shot time to shoot at your preferences time with lantus it's best to make adjustments at 15 min pero cycle. (Max 30min per day)
Changing time quicker than this can affect the cycles, bringing the shot time forward cand act as a dose increase and delaying the shot times can act as a dose reduction)

Did you get those ketone tests, (it's really important to keep monitoring that, with DKA in her history so recently, and with reducing insulin dose we must make sure they are not resurfacing. TBH that's a more important factor when considering her dose than her bf or whether you are doing TR or slugs, please keep on top of them they can develop very quickly)

How's her appetite
 
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Suzanne & Darcy said:
Still looking good. The time change would blow my mind except I use the world clock on my phone to tell me what time it is in Malta! :cat:
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I had previously googled the BG meter (just like you) to see if it was human or pet, although couldn’t confirm whether the company had a pet division so wasn’t 100 percent sure it was human, and even read some interesting studies about the meter’s use on dogs …. but I’ve never used the world clock on my phone (how on Earth did I not know that!). Learn something new around here every day. I NOW know what time it is in Malta without doing math. Thanks Suzanne!
 
Good morning Monica.

At what time did you shoot this morning?
She was a little higher for amps, but nice to see she's coming down at +2, so paws crossed she comes back down to green.

Have you managed to get a ketone test? Is she eating well? Is she behaving normally? (Playing, purring...)
 
Good morning (afternoon) Monica. You are doing an amazing job taking care of Mia. And here I thought that last night you were getting some much needed sleep…. but this morning I see all those blue tests. She is very stable in blue numbers right now so you can probably back off the testing a little bit (although I can’t believe I am saying that… as a testaholic myself.)

If you are not able to get ketone tests from the litter box, consider getting a Blood Ketone Meter, which works just like a regular glucometer (ear prick blood drop) with different test strips. I have a Nova Max Plus blood ketone meter, but I don’t know what different brands are available in Malta.
 
Gill & George said:
Hi Mónica,
I see you're in Malta, like us (Spain) clocks will be going back an hour. ( Heads up @Suzanne & Darcy @Bron and Sheba (GA))
Unlike our USA friends where it's next week.

When it comes to Mia's shot time it should be 12 hours after pmps so If you shot at 7pm tonight, tomorrow morning you would need to shoot at 6am be side of the clock change.

To adjust your shot time to shoot at your preferences time with lantus it's best to make adjustments at 15 min pero cycle. (Max 30min per day)
Changing time quicker than this can affect the cycles, bringing the shot time forward cand act as a dose increase and delaying the shot times can act as a dose reduction)

Did you get those ketone tests, (it's really important to keep monitoring that, with DKA in her history so recently, and with reducing insulin dose we must make sure they are not resurfacing. TBH that's a more important factor when considering her dose than her bf or whether you are doing TR or slugs, please keep on top of them they can develop very quickly)

How's her appetite
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Hi @Gill & George ! Yes I realized that yesterday evening thankfully so was able to adjust my alarm for her morning shot. So she got her morning shot at 6.45 am instead of the old 7.45am today. So will give her the evening shot at 6.45pm and then slowly start adjusting back to our usual schedule 15min each day.

Will be extra ontop of her today to get a ketones test done!
 
Suzanne & Darcy said:
Good morning (afternoon) Monica. You are doing an amazing job taking care of Mia. And here I thought that last night you were getting some much needed sleep…. but this morning I see all those blue tests. She is very stable in blue numbers right now so you can probably back off the testing a little bit (although I can’t believe I am saying that… as a testaholic myself.)

If you are not able to get ketone tests from the litter box, consider getting a Blood Ketone Meter, which works just like a regular glucometer (ear prick blood drop) with different test strips. I have a Nova Max Plus blood ketone meter, but I don’t know what different brands are available in Malta.
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Hi @Suzanne & Darcy ! Luckily my partner in crime is with me in this, so he has taken the night shifts the last 2 nights and I have been getting up in time for her morning shot when he goes to bed ☺️

Will continue to test every 2 hours for this cycle and as late as possible after her evening shot, so will probably get in the +2, +4 and +6 this evening too but will have to miss out on the rest.

Will be extra ontop of Mia today to get a ketone test done, if I still don't manage I will get a ketone tester tomorrow. Won't be able to get one until tomorrow anyways since things are closed today ☺️

Should I be concerned that she hasn't gone down into green numbers for last evening/nights cycle and not for this cycle so far either?
 
MonicaT said:
Hi @Suzanne & Darcy ! Luckily my partner in crime is with me in this, so he has taken the night shifts the last 2 nights and I have been getting up in time for her morning shot when he goes to bed ☺️

Will continue to test every 2 hours for this cycle and as late as possible after her evening shot, so will probably get in the +2, +4 and +6 this evening too but will have to miss out on the rest.

Will be extra ontop of Mia today to get a ketone test done, if I still don't manage I will get a ketone tester tomorrow. Won't be able to get one until tomorrow anyways since things are closed today ☺️

Should I be concerned that she hasn't gone down into green numbers for last evening/nights cycle and not for this cycle so far either?
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Don’t be concerned. She’s getting good numbers and I was a little disappointed that she didn’t dip into greens, but we hold this dose a bit longer to make sure we are seeing the full effect of this dose before making adjustments. It’s a lot better than lime greens, too!
 
Suzanne & Darcy said:
Don’t be concerned. She’s getting good numbers and I was a little disappointed that she didn’t dip into greens, but we hold this dose a bit longer to make sure we are seeing the full effect of this dose before making adjustments. It’s a lot better than lime greens, too!
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@Suzanne & Darcy Ok thank you! Will try to be patient in getting her down to green numbers! And yes definitely loving seeing her with stable numbers instead of jumping up and down from lime green all the way to yellow! ☺️
 
Gill & George said:
No problem.

Yay for negative ketones!

Well done with the litter box lurk:)


Paws crossed we see some green tonight
My guy always went for a pee after breakfast, donhe was easy to catch.:woot:
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@Gill & George yes I finally managed to catch her! She's such a quiet sneaky cat

Just had her +2 BG, and it hasn't really decreased since her preshot, which I'm finding a little strange
 
MonicaT said:
@Gill & George yes I finally managed to catch her! She's such a quiet sneaky cat

Just had her +2 BG, and it hasn't really decreased since her preshot, which I'm finding a little strange
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Onset with lantus is around +2, the fact she hasn't gone up at +2 after her food at pmps would suggest that she's going to have an active cyy, by that I mean, that I would expect her to continue to go down a bit more, as the cycle progresses. Maybe not as much as with previous ones. Where she appears to have onset a little earlier.


But let's see.
 
Gill & George said:
Onset with lantus is around +2, the fact she hasn't gone up at +2 after her food at pmps would suggest that she's going to have an active cyy, by that I mean, that I would expect her to continue to go down a bit more, as the cycle progresses
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@Gill & George Oh ok, just found it strange when comparing to the previous cycles where she had been going down at +2 already. Will be testing at +4 and +6. Not sure if I will manage +8 though
 
MonicaT said:
@Gill & George Oh ok, just found it strange when comparing to the previous cycles where she had been going down at +2 already. Will be testing at +4 and +6. Not sure if I will manage +8 though
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Yep the previous cycles she's been onsetting earlier perhaps.

It will be interesting to see what happens.
Absorption of insulin can vary between one cycle and another and that can lead to variability in the cycles, we will be looking at trends to guide us with dosing. It may be that she will require a dose increase, but let's see what happens.

Usually with the depot insulins like lantus we usually wait a minimum of 6 cycles before changing a dose and we usually hold the starting dose s little longer. With cats that have had DKA we sometimes need to be a bit more proactive with the dosing, if we were start to see ketones or if Mia lost appetite, or got lethargic or sick we might need to up the dose sooner.

For now her numbers are in blue, which is good ,her cycles are smooth, we would ideally like to see her spending more time in green, ( BG of a healthy cat 50-80) she may yet get there on this dose, but we may need to up her dose to nudge her there, for now though it's important to be patient and not rus.

If you take a look at George's spread sheet you can see what the SS of a cat that surfed his way into remission looks like.
 
May I ask, if you remember, when she ate today and at what hour she ate during the a.m. cycle?

Any ketone tests today? I am thinking she will not have much in the way of ketones, but it’s best to check.
 
Suzanne & Darcy said:
May I ask, if you remember, when she ate today and at what hour she ate during the a.m. cycle?

Any ketone tests today? I am thinking she will not have much in the way of ketones, but it’s best to check.
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@Suzanne & Darcy I am feeding her small meals throughout the day, and have my own SS in fact where I write everything including amounts and times of feeding. Was there anything specific you were thinking about? I'm guessing it's in regards to her BG readings?

Managed to get a ketone test done, which was negative, it's in the SS ☺️
 
MonicaT said:
@Suzanne & Darcy I am feeding her small meals throughout the day, and have my own SS in fact where I write everything including amounts and times of feeding. Was there anything specific you were thinking about? I'm guessing it's in regards to her BG readings?

Managed to get a ketone test done, which was negative, it's in the SS ☺️
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Regarding the food, I was looking in your notes to see if you wrote down what you fed her and when. A lot of people do write in the comments section what they fed/how much/at what hour in the cycle they fed. It’s helpful to see how your cat responds to carbohydrates.

How’s her weight and appetite? Does she seem to be feeling well? No ketones! I’m very happy with that.
 
Suzanne & Darcy said:
Regarding the food, I was looking in your notes to see if you wrote down what you fed her and when. A lot of people do write in the comments section what they fed/how much/at what hour in the cycle they fed. It’s helpful to see how your cat responds to carbohydrates.

How’s her weight and appetite? Does she seem to be feeling well? No ketones! I’m very happy with that.
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@Suzanne & Darcy Oh ok! Yes I can definitely do that ☺️ her feeding times are completely random at the moment though, I think I just stuck with constant feeding after she was in DKA where I was just feeding her all the time as much as possible.

In total during a day she eats approximately 160-180 grams of canned wet food. The brand is called Oasy, and it's their mousse I am giving her.

I would say she had a very good appetite and jumps up to eat most of the times I refill her bowl during the day. I wouldn't mind seeing her putting on some weight though, we weighed her at the vet a week ago and she had lost 200grams since she first was weighed maybe 1 week after diagnosis. So I am hoping she would start putting on weight again and get her up up to 4kg at least, now she is at 3.6kg.
 
Question about food, how does it work with cat food that says complimentary and not complete? Found a couple of brands that are low carb, but they are not complete.
 
MonicaT said:
Question about food, how does it work with cat food that says complimentary and not complete? Found a couple of brands that are low carb, but they are not complete.
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In the U.S. those foods are labeled as for “supplementary feeding” and it means they are not nutritionally complete and should not be used as the main diet because they are lacking essential nutrients.
 
Suzanne & Darcy said:
In the U.S. those foods are labeled as for “supplementary feeding” and it means they are not nutritionally complete and should not be used as the main diet because they are lacking essential nutrients.
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It's the same here, they're not nutritionally complete

Monica have you had a look at this SD
https://docs.google.com/spreadsheet...l9hUtHy6Gs9oRBqlz4nPGKxtySA/edit?usp=drivesdk

A lot of the food is available in mainland Europe ( even though it says UK) , I of course font know what the supply in Malta will be like, hope it's useful.
 
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