? 10-8-18 Gouda AMPS 244, +11 87 | SKIPPING PM INSULIN. Suggestions?

Hi there, new to FDMB. I have recently transitioned my cat Gouda to all wet food diet. I took it upon myself, against my vet's advice, to switch him to high protein/low carb wet food (FF Classic) without option to free-feed on any dry food. He is taking well to it so far. Previously he was on Hill's d/m wet and dry. per vet's advice. My vet supports and appreciates my home testing but after reviewing my spreadsheet, now wants us to increase Lantus dose to 3.5 units, twice a day, with wet/dry Hill's d/m. I think this is too much.

I know my spreadsheet seems all over the place... this is because at first, I followed the vet's orders. Now I have changed my ways and I am trying to take tips from the SLGS method, even though we technically never "started low" since vet started us at one whole unit twice a day.

Today, Gouda has particularly low numbers. He is still receiving 2 units 2x/day. I don't have a lot of data from today but the AMPS was 244 and the +11 was 87. I waited to feed and tested an hour later, and the +12 (PMPS) was 71. Since his number was less than 150 and since he wasn't climbing as time went on, I decided to feed him and skip the shot altogether.

I am scared to sleep through the night without testing him, because I've never experienced him in low range. I don't know how to decrease the dosage in a safe way but feel like he might be better off at 1 unit 2x/day. How do you suggest I decrease his dosage, and over what period of time? Do I decrease in units of 0.25 over a week? I only recently switched him to wet food only, and even more recently to Fancy Feast (instead of the higher carb wet food that is Hill's d/m). I don't want to skip insulin shots because it scares me. But maybe this is OK? Just trying to "get to know my cat"... don't have enough data but don't want to keep over-carbing him because I am scared to leave him for 8 hours at a time.

Thank you for reading and for any advice or suggestions.



Some background...

My name is Lauren. My husband and I adopted our male cat Gouda from a rescue in 2015. He is an 7 year old Scottish Fold with straight ears. He was diagnosed on 7/24/2018. He has been on Lantus since diagnosis. I have home-tested since the beginning, because I was fortunate enough to find FDMB in my fervent researching phase, post-diagnosis. I use ReliOn Confirm Micro human meter. On weekdays I try to get a test in the morning before work and 3-4 in the evening when I get home. That's ideal. On weekends, I try to test every two hours, since I am still in the beginning phase and I am adamant on collecting as much data as I can. I know my sheet seems all over the place My vet supports and appreciates my home testing but continues to give me advise to raise the dose of insulin, feed Hills M/D wet food twice a day and to allow Gouda to free feed on Hills M/D dry food throughout the day. I do not agree with this due to my research so far. So, I have completely switched Gouda to Fancy Feast Classic Line, a high protein, low carb wet food, twice a day only. No dry food.

 

Welcome here... I'll have to tag @Marje and Gracie since you have a scottish fold..... that's her babies too.

First of all, please write in your ss when you changed to all wet food so we can tell if that's part of the response.
You are correct not to increase yet because if you just made the food change, that can drop numbers.

Write no shot or skip in tonite's dose space because later on , someone will ask , or will wonder what dose you gave.

It sounds like you have been doing lots of reading because you are figuring stuff out on your own. Many vets haven't had personal experience with feline diabetes or depot insulins, so they can give erroneous advice.

You can start over at 1 unit if you choose too.... especially if you changed the food in the last couple of days. You would hold that dose for a week unless numbers indicate otherwise. And then you would increase ( or decrease) by 0.25 u at a time.

You are okay tonite since you didn't shoot. The depot is draining.
You will need to choose a new dose if that's the way you want to go by tomorrow mornings shot.

I'd prefer to know what day you changed the food first but as I said, if you just did that in the last few days.....
starting over will work in your particular situation.....

 

Hello and welcome. Could you add SLGS to your signature line as well? That'll let us know quickly which dosing guidelines you want to follow.

Can you tell me a little bit about how Gouda was diagnosed as a diabetic? Any history of DKA or ketones? Are you testing now for ketones? I wouldn't want to reduce the dose too much depending on the answers to those questions. He definitely did earn a reduction down to at least 1.75 units.

I also see that yesterday you dosed the AM dose at 8AM and the PM dose at 6PM. For Lantus, it's best if you can dose as closely to 12 hours apart as you can. You can move the times 1/2 hour once a day, or 15 minutes per cycle to get back on time. Shooting 2 hours early acts a bit like an increase. I'd also like to suggest a change to how you entered the data in yesteday's spreadsheet. In the AMPS column, put 64@+12, 197@+14. That lets us know you stalled two hours before shooting. Then put the 0.5 units I think you gave in the units column. We don't always remember to look at the remarks column first thing, and at a glance it looks like you skipped a dose instead of delaying yesterday morning.

 

Your vet is an idiot (a common problem we see a lot here) To be fair, vets only get 5 hours of education in school on diabetes and that covers both dogs and cats. They tend to treat their cat patients like dogs (since they see more diabetic dogs than cats in most practices).

They really don't have the time to stay up to date on the latest treatments for every disease in every type of animal they see. That's the great thing about the message board....the people here have the time to research and stay up to date on the best treatments for diabetes and the conditions that tend to come with it.

You don't want to drop too far back because then you might waste a lot of time building back up to a dose that works. I'd suggest dropping back to 1.5 or 1.75 and start from there. If that proves to be too much now that you're on the low carb food, he'll show you in his test results.

Have you read the sticky on "Is TR possible with a full time job? Yes!" ? ….Even if you're not doing TR, if you're working full time, there's lots of great ideas on how to keep your kitty safe while you're away

 

Thanks for responding. I added SLGS to signature. He was vomiting every day for a week, always at least once a day, up to sometimes 5 times a day. He appeared to have lost a lot of weight. He was a dry food-only cat then and we couldn't understand why he wasn't keeping his food down, even when feeding some wet food or chicken broth. I took him to the vet because he look very thin and was acting very tired, with vomiting present. The vet tested his BG and notified us that he was almost hypoglycemic, with directions to feed him Hill's d/m dry and wet food, and as much as he wants. I've since switched him beginning on 10/5/18 partially, fully to wet food only on 10/6/18 because I knew I would be home the whole day.

I am not aware of DKA or ketones. I am not currently testing for ketones.

 

Hello and thank you for your reply. I made the changes to the SS. I began a partial switch to wet food on 10/5/18, fully switching on 10/6/18 because I knew I would be home the entire day on 10/6. Thanks for the insight.

 

Thanks for the note! It's discouraging because my vet is supportive of this entire home testing process. Just doesn't understand the effect of carbs on my cat. I hope to be able to report back my numbers and maybe then the vet will take notice to the changes. Thank you for the dosage suggestion. I have read that particular thread and find it very useful as I am gone 8-9 hours a day and work in a town away, so not possible to come home at lunch. I will re-read again. I'm really glad I decided to post tonight.

 

Hi Lauren, and welcome to Lantus & Levemir Land, the nicest place you never wanted to be!

You've been given some great pointers, and I see you have done a lot of learning on your own, all of which is great. I, too, hope that your vet is supportive when you have some data to back up the changes you have made on your own. Some vets handle that well, but others don't, so be prepared for some push back if yours falls into the latter category (I'm lucky that mine is in the former). Many people here have had to adopt the nod and smile method when discussing FD with their vet (nod and smile when they give you instructions on what to do about it, then go home and continue to manage it yourself). If you like your vet otherwise, this can be a great way to keep the relationship on good footing. We all need our vets and don't want to ruin that relationship for sure!

In case you haven't seen it yet, here is a post we put together for new members, sort of like a Q&A about using the forum to full advantage.

Keep reading and keep asking questions. We love to help!

 

Hi There and Welcome,
Marje is just going to love your Orange boy, he's a gorgeous, I just want to smmoosh his face.

Am I right in thinking that you have cut out dry food altogether on 10/6 ?
The Hills DM dry is HC, my vet also wanted me to use that food, we had to agree to disagree on that to begin with. I think she was really just being led by the manufacturers rep/ marketing.
His carbohydrate load will have decreased dramatically, I would highlight it clearly in the SS as it's a very important event, perhaps insert a line and write something like no more dry from this point.

It's great that your vet supports home testing and if she is willing to learn with you then you're on to a winner, George was my vet's first diabetic cat, and she was big enough to admit that, she was cautious about this site at first, she was also very cautious about dosing, I shared my data on hometesting and told her when I was changing dose, etc but she just let me get on with it.

Changing the dose at 1u steps is way to fast (as I know you've come to realise), but it''s not unusual for vets to suggest this, I think most of them don't think it's possible to measure less than 1u, one of my vets was gobsmacked when I showed him what 0.25u looked like not to long ago.

I agree with Wendy you probably don't want to take the dose back down too far, it can really set you back. But the 2u does seem to have been getting him into the range for reductions on SLGS, so at taking him to at least a 1.75u may seem sensible.
But given the recent removal of all dry(assuming this happened on Oct6), you may want to be a little more conservative and take him down to 1.5u. See where he is in the morning. If he is high in the morning don't let that persuade you to shoot a larger dose, with lantus we need to look to the nadirs for dosing, and those have been green, high numbers will likely be a bounce or effect of NS (or combination of both)

I like your schedule for testing on your work day, getting a test before you head out the door to work and getting a test as you walk in the door can give you an indication of what went on during the day.
And those scheduled PM tests will also allow you to judge what the pm cycle is doing.
Are you planning on running curves on your day of, or gathering some more spot checks?

Have you got an automatic feeder?
If you haven't I would recommend you get one, having the ability to dispense food at regular intervals for Gouda, will be a great tool to keep him safe when you are away at work, or sleeping.

 

Thanks for the advice, I have noted his first wet food only day in the Remarks section and highlighted the date on my SS. I decided no more dry food beginning 10/6/18. For a few days before that, I began slowly increasing more wet food and decreasing dry food.

I have been trying to run curves on Saturdays/Sundays. I will continue to do this as much as possible. If I can't be home all day, then I will spot-check as I can.

I do have an automatic feeder. I have been freezing a small portion of low carb wet food to dispense midday while I am at work. Should I note this in my SS? It's only a little, probably only 1 ounce of LC wet food, around 12 p.m. each day. It thaws in the auto-feeder and then dispenses at 12 p.m. It's always eaten when I get home.

 

This morning I gave Gouda 1.5 units, thanks to all of your suggestions. We will see how he responds.

 

Excellent, is that at +5 or +6?

I liked to keep note of when and what I fed on the SS then if you need to change something or feed extra you can see at a glance.
It's part of the equation to getting him regulated.

That's a good plan.

Good luck with the dose. Mid yellow is not bad after a skipped shot.

Hopefully he will give you numbers that you will be able to dose consistently, changing the dose frequently plays havoc with the depot as it adjust up and down and that in turn makes the numbers 'wonky' which makes it hard to see how well a kitty is doing on a dose.

 

12 p.m. is +7 for us. Thanks, good idea. I will begin noting.

I have definitely felt the confusion since we have been changing things frequently. I am looking forward to consistency now that I have completely made the diet switch to LC wet food, and I have Gouda back at a lower dose. I will be looking at more of your SS's to see how I can better record things in my own.

 

You may want to reassess the midcyle feed to coincide with onset and nadir, I'm out at the mo will write more later.

 

Oh Chris - LOL!!! Nothing like the hammer over the head approach there, huh? Although I agree with you completely It does sound like her vet was supportive of her efforts - albeit sadly mistaken on so many things - like the food ... gotta say your calling a spade a spade gave me a laugh out loud moment there..

 

Beating around the bush just disturbs the bugs....LOL

 

He’s such a cutie!