New Thread for Dialing in on Loki's Dosing

Just starting a new thread to continue the need for guidance with Loki's dosing. Below is the link to the previous thread that lead to here:

https://www.felinediabetes.com/FDMB...e-still-needing-guidance-this-evening.272568/

@Bron and Sheba (GA) @FrostD

Starting where we left off from the other thread:

I'm sorry, I’ve been so exhausted, did I misunderstand? (even though I thought I understood the other night ) I thought I was needing to feed the higher low carb food in order to be able to keep the dose higher at 0.75, for his DKA? I gave the reduced 0.5U dose yesterday AM, went and got the higher low carb food, and then for PM I increased again to 0.75 after feeding the new food. Should I not have gone back to 0.75?

To note: Yesterday after the 0.5U AM dose, and with LOW CARB food, he stayed higher, and barely dropped into the high 100s (based off the Libre graph. I didn't get an afternoon reading because I was running around getting the food). Then after the PM 0.75 dose, and AFTER the HIGHER LOW CARB food, it's the same. His PM cycle looks basically identical to the AM cycle. So maybe the 0.5 dose is not enough insulin right now? And then the higher low carb food kept him higher through the night, but also from dropping low? He might be bouncing again, and needing to get used to the new reduced dose?

Loki's SS is up to date, and as of 6 hours ago, his ketone pee test was negative (the strip did not change color). This is noted in the SS.

This AM, I also dosed 0.75U, and fed the higher low carb food. Will continue to monitor. Thank you!

 

Bron is in Sydney AU and is almost definitely sleeping, although I don't know how early she rises. It's just past 7am where she is.

Melissa (FrostD) might be around but also has a baby she's dealing with. Let's see if we can get some other eyeballs in here...from what I read you were advised to reduce to .5U

I just re-read Bron's advise, it was to give .5U in the morning and then see how things go, if no ketones and eating well then give .5U in the evening as well. And she also wanted to see what Elise's (tiffmaxee) opinion on the dose was. Elise concurred with .5U

 

@tiffmaxee

 

Looks like you fave .75 so stick with that unless someone who uses Prozinc says otherwise. Keep checking for ketones.

 

Oh dear I hate to muddy the water...

My concern at 0.75U is when this bounce breaks you'll have quite a bit of downard momentum that the higher-low carb food won't much help. My preference would be to do 0.5U at least until this bounce clears.

 

But on the 0.5U, without the higher-low carb food, he barely dropped into the 100s. I feel like there was progress, and he was breaking a bounce, hence all the dose reductions. I thought the idea was to be able to keep him on more insulin bc of DKA, and feed higher-low carb foods so he could handle the higher dose without dropping. And since he remained much higher on 0.5 with the low carb food, what is the point of reduction and feeding the higher-low carb foods? Isn't this increasing chances of DKA/ketones? The higher-low carb foods are not for the 0.75 dose? I am quite confused now.

 

Hi Lauren,
The reason Loki was not in lower BGs with the 0.5 U yesterday was because he was (and still is) bouncing from all the greens the day before.
What Melissa is concerned about is that when he breaks the bounce, if he is on 0.75 U it might drop him too low. And she has suggested staying with the 0.5U at least until the bounce breaks. As long as there are no ketones in the urine, I think that is the safest thing to do. Once he breaks the bounce, we can reassess the dose to see if it needs increasing. Safety is out main priority.
While he is bouncing you don’t need to be feeding any higher carb foods. But keep an eye out for the bounce breaking.
Does all that make sense?

 

Hey there, it's starting to make sense. If you look at the end of the previous thread, you both advised me to start feeding him the higher-low carb foods after yesterday's AM 0.5U dose, so that's what I did starting in the PM. Where I messed up is by giving him 0.75U since last night. Now I don't need to feed him that food? I think the food part is confusing me now. Should I be or not?

Also, I messed up because I gave him 0.75 again tonight. So I'll have to just see what happens. I'll give 0.5U in the AM tomorrow.

 

Don’t worry, it can be confusing!
I wouldn’t feed him the higher carb food while he is bouncing…..as the numbers are high. The 0.75 units will eventually bring the BGs down when he comes off the bounce so be aware of that during the cycle tonight if you see the BGs trending down. Once the BGs come back down to normal you might need to feed some higher carb food. Does that make sense? Keep asking questions!

 

And to add - the goal is not to overpower a bounce with more insulin (many people tend to think that, not saying you do, just mentioning it).

Bounce breaks can be unpredictable, both in (1) the sense of you may think a cycle may be continuing a bounce then they drop out of nowhere and (2) how much extra downward momentum they may have. Adding more insulin to that can quickly cause trouble, so best to just to hold the dose steady and let his body clear it out.

 

@FrostD @Bron and Sheba (GA) So do I give 0.5 or 0.75 in the AM? And through the bounce I guess?

 

I would go back to the 0.5 U until you see what the BG numbers are after the bounce breaks.

 

Ok, thank you both for talking me through the misunderstanding. Will keep you updated.

 

Hopefully this doesn't add confusion - sometimes it looks like they broke a bounce by coming down into blue like he did a few nights ago. So sometimes people make decisions off of that alone...but in reality the bounce hasn't fully broken. If a cat has been pretty consistently seeing green nadirs, a true/full bounce break usually brings them back down into green. That's why we're saying to wait and see, at least til the full 6 cycles is over.

So it's possible the 175 the other night was the break, but im leaning more towards it wasn't, and he's still going to come down more.

So much of this is what we tend to call our "crystal ball"...some days it works great, other times not so much!

 

Based off Loki’s SS, can you tell me which cycle is #1? So I know where I’m at in the count. A cycle is 12 hours right, from shot to shot? So I guess nothing from the end of 2022?

 

Start counting after the run of greens that triggered the bounce on 1/4 pm cycle. So start counting from the am cycle on 1/5.
So you are up to cycle 5 ( am cycle 1/7)

 

Perfect! Thank you! I’m technically on cycle 6 then, I’ve given the PM dose already. I just haven’t filled out today's info yet. But I can tell you his numbers have been high all day, and are still so even now.

 

Watch for the BGs falling. They can sometimes fall all the way to the end of the cycle quite fast. If Loki does not go back down into lower numbers it will be a failed reduction. But give it time.

 

Thank you for that info! Could the higher-low carb food still be making a difference in his system? He last had some yesterday. And then my other cat also vomited some dry food today and Loki ate it while I was asleep could these things be making an impact like this?

 

You might like to start a new thread for Loki as this one is getting very long…..disregard this….I must have opened the wrong thread when I wrote this
Link this current thread to the new one for continuity

 

The dry food could be influencing the BGs but the higher low carb should not at this point. How do you know Loki ate the dry food?

 

is the cap 20 now? I thought it was 50 posts

 

It is 50 posts Kyle. Not sure what happened ……I think I must have clicked and opened on the wrong thread
I edited the above post

 

Because Loki has always been the vomit-eating cat. There was a new puke area right next to my bed when I got up, and there were remnants of it left, and this has happened many times. I had never had a cat that ate the other's vomit in my life until him lol. My other cat, Baby..well the name suits her haha! She's very dainty and particular. She never eats vomit, and wouldn't dare eat her own lol.

Loki's numbers are still quite high as I get closer to AMPS, just over an hour away from the end of the 6th cycle. You said this may be a failed reduction, and I meant to ask if that was the case by this morning, should I increase to 0.75, or stay at 0.5? I will stay at 0.5 this morning just to be safe until I get a response from you or @FrostD. Thanks!

 

By my counting you are only up to cycle 5 of the bounce so stay with the same dose.

 

I just haven't filled in the SS, which I'm working on now. This morning ends cycle 6

 

Ok. It’s confusing because I live in Australia and our times are different. So I just go by the SS.
I’d still stay with the same dose for this morning as sometimes the bounce can run a bit late.

 

SS is up to date now, please check

 

Ok cool, I'll give 0.5U this morning. If he is still high by tonight's PMPS, should I increase to 0.75? Or wait another cycle? Again, I can wait to see what @FrostD thinks, but I'm just trying to stay ahead so I'm not left guessing alone later.

 

See what Melissa says. But most likely it would be safe to increase. Are you still checking ketones ?

 

Yes, when I catch him peeing, but haven't been able to since day before yesterday. It's always on the list to do; am determined to get one today.

 

Yes let's see what he does today. If not under 150, I would increase back to 0.75U

 

I just got home, so obviously wasn’t able to get readings for a few hours. He at least went under 200 today, but based on the Libre graph, it looks like he didn’t dip below 190-180ish. Kind of makes me a little nervous to increase to 0.75, since it’s kinda close to 150..like maybe he needs one more cycle to see? Not sure.

 

@FrostD

 

@FrostD I gave the 0.75 just now, his PMPS was “HI,” and like you said, he didn’t go below 150. So will monitor and see how he does

 

When did you last test for ketones?

 

Good decision! Increase is warranted, and looks like he's bouncing again...

Remind me of your feeding schedule? Wondering if we can tweak that to slow the drops a little more and hopefully prevent/minimize the bounces.

 

I was just able to do a pee strip check for ketones an hour ago, and it was negative. The strip did not change color. Which kind of weirds me out a little, as if it almost isn't working if it doesn't do anything..like hello are you working? Lol.

So far, feeding has been like this: Loki is fed at his AM and PM pre-shot times. Then, depending on my day/night, I will make a snack for him @ +3-4, or I leave one out if I have to leave/need to sleep. Then it's the same for a +6-8 snack (either making it at that time if I'm home/awake or leaving one out if I'm not). So like 2 main meals, which is the FF pates. Then 2-4 snacks depending on how he eats that day, which are either another can of FF pate, or a Sheba Perfect Portions pate. I just received a Cat Mate C500 auto-feeder in the mail today, so I need to set that up and see how he uses/reacts to it. It can set up 5 meals for the day.

 

Are you feeding in the pm cycle as well?

Excellent there are no ketones. If it doesn’t change colour at all… that’s great!

 

Yes, that's the feeding for both AM & PM cycles. And then of course, pick up food two hours prior to pre-shot.

Ok, glad to know about the strip! It just kinda messes with me when it does nothing lol. Glad he is remaining negative!

 

@Bron and Sheba (GA) @FrostD

Since you were asking me about feeding, I wanted to know if it's totally okay to feed any low-carb food that's on the food chart? Because I'm pretty sure Loki is over Fancy Feast and I need to switch..which sucks because FF is a great price lol..but he keeps not eating much at all of the FF, and it's not nausea (btw he's still on the Cerenia & Ondansetron), because when I gave him Sheba Perfect Portions Pate instead, he feasted on that like he hadn't eaten in days! Ate it all! The difference was astounding.

He's been eating the Sheba well for snacks, but I was just thinking I should maybe feed the Sheba for meals too, since I have confidence he'll eat that. And we all know how Sheba comes in small twin-pack portions right? So of course I would double up for a meal. And can also maybe try some different kinds he might like until I find a good combo of different foods he won't tire of. Just wanting to make sure this is okay to do.

 

Yes he can eat whatever!

Do you think he'd eat closer to +2? The issue is he has a big drop by +2.5/3 a lot of the time, slowing that down may help. It may mean that his AMPS and PMPS meals may have to be a little smaller.

I'm guessing the second one may need to move up a little bit one variable at a time...

 

Awesome! Will try some stuff out then

Yeah, I can play around with this for sure and see how it goes.

Are you meaning the second snack of the day? If so, then yeah it will all need to be adjusted I assume

 

Yes, second snack

 

@Bron and Sheba (GA) @FrostD

I think Loki is trying to break his bounce. He had better numbers today, but went down to 65 a half hour ago. So I suppose this calls for a reduction back down to 0.5U for the morning? His SS is up to date. I have not fed any high-carb food, as I'm learning to get a feel for the lower numbers, just waiting to see what he does.

 

Yes a reduction back to 0.5 U.
Thanks for hi lighting the ketones results in the remarks colour. Vey helpful. Keep the testing up for the time before. Great it is negative.
Sounds as if he wants to swap foods. How do you think his appetite is going generally?

 

Yes, I will keep up with the ketone tests.
Yeah, unfortunately he seems completely over the FF, and he's enjoying the Sheba pates much more right now, he's eating those really well. He definitely gets eager to eat, and wants food, he knows when I'm making it and is waiting. But he doesn't gorge himself like he was leading up to the DKA event. So after a meal, he'll usually leave a little food left in the bowl for him to come back to when he wants. I think he's feeling better, and that it's a matter of getting a food he likes. I'm gonna get a couple from the chart and see which ones stick

 

Sometimes after they have been sick, they can associate the food with the sickness and can go off it. I think getting some new foods he will enjoy is a very good idea.

 

That makes sense, poor little guy..
I was just over on another thread, about Mewman, and you were commenting about feeding freeze dried food. Loki is loving freeze dried bits, I give a few as treats with his shot and pills. That's not a bad idea to add of them to the feeder, or his food. I just have no idea what an appropriate amount would be? Does it even matter?

One of the products is by Whole Hearted, and it's just freeze dried chicken liver (only ingredient):
https://www.petco.com/shop/en/petcostore/product/wholehearted-chicken-liver-freeze-dried-cat-treats

The other one is by Instinct, and it has a longer ingredient list:
https://instinctpetfood.com/products/raw-boost-mixers-chicken-freeze-dried-cat-food-topper/

It says made without grain, potato, corn, wheat, soy, by-product meal, artificial colors or preservatives. But I'm not sure if these ingredients are fully okay or not, here is a picture.

 

The liver is very good for them but don’t give too much each day otherwise it is toxic. Very safe to feed as long as only a couple of bits a day.
The other looks ok. Has several veg in there that isn’t necessary but should not be high carb I don’t think.

 

Good to know.. I should probably just find some that is only chicken, or salmon? They can have much more of that right? I don't like giving too much fish stuff either.
I might just stop the Instinct one with all the ingredients, you never know, ugh

 

So we are at 10.25, and Loki is hanging in the low 100s (SS is up to date). This happened last week on Jan 3rd, where his AMPS was lower like this. I'm getting nervous the same thing might happen. If it is, based on last week's advice, basically I should either give a token dose, a half dose, or the full (now reduced after tonight) 0.5U based on how I can monitor. I have no issues monitoring today if I give 0.5U. If I give a half dose, it would be half of the now 0.5U we are reducing to right, so 0.25U? Isn't a token dose 0.5U anyway?

@Bron and Sheba (GA) @FrostD

I'm also going to start another new thread to continue this after this morning's dose.

 

It’s probably easier to have a chicken or beef one that you can give as much as you like. But a bit of liver is fine.
I feed my cats a raw diet that I make myself and I give 5% liver a day of the overall amount fed.
If you are feeding a wet diet they would already have liver or vitamin A in it so you would not want to give much. Most cats love it. It’s fine to give a bit.
You may be able to look up the other one on the list and see how many carbs are in it.

 

He looks like he’s heading up. See what he is at AMPS. I’m heading to bed so won’t be awake but you could tag @Bandit's Mom although she hasn’t used Prozinc.
As the new dose is 0.5U… a half dose would be 0.25 U.
A token dose is about a 1/4 or less of the current dose.
With DKA in the recent past you don’t want to skip. If he’s already up to 149 at +10.25 he could teach 200 by AMPS.
I think he will likely bounce from the greens. I would give at least a half dose if he’s around 175 and a full dose if he’s around 200 as long as you can monitor and have supplies.

 

Thanks, Bron!! Get some sleep for me too!! LOL..