? 05-30 Dose advice Dagobah & Nikita

Hi everyone!

Here’s a little feedback on this sh*tty week!

Last Wednesday Dagobah was very sick, she had tracheitis and didn’t want to eat (or couldn’t). So we feared for another DKA …

She made things really complicated, because when Nikita went sick on Friday night, we had to use « magic food » (chicken liver, fish, raw meat…) to make Nikita eat, and Dagobah decided that she would eat the same things as Niki or nothing…

Then I had to « fight» and cheat with them for their medications



Today I’m totally exhausted, but BOTH ARE FINE!!!

They eat normally and with pleasure!


I just wonder if they are not bouncing? So if someone could check on their spreadsheets and give me an opinion, I would be really happy (for now I am not sure to think correctly, so I would like to know if I have to reduce the dose or keep it stable)



I also want to thank @Stacy & Asia, @Gill & George, @Phoebes, @Dyana @Wendy&Neko for their wines and vines ;-)

And a really huge Thank you to @Stephanie & Quintus who didn't stop support me the best she could, however I wasn’t in the mood to listen to her

 

Some extra information: there's a food change in the works, from Animonda Carny to Almo Nature + MAC's -- might be relevant information.

When I look at Dagobah's spreadsheet and rising numbers I would definitely want to know if she has ketones. You told me the other day you had only one strip left, did you manage to get others, or could you get others? Knowing if ketones are present or not is precious information to know if one should give an agressive insuline dose or not.

With her recent values I would take the option of increasing the dose (if you're giving R to bring her down then clearly the L dose is not enough). You have good surveillance in place and know how to deal with low numbers if you go too high with the dose. I would personally prefer that risk than ketones and DKA, which is the risk you're running by not being aggressive enough with the insulin.

Also, I think I recall seeing somewhere that for cats who are prone to ketones (and I think it's pretty clear Dagobah is one of those) slightly higher carb food might be better.

I know this isn't your question today but based on @Stacy & Asia's extremely positive experience with TID dosing, and what I know of your sleep&life schedules, I think it would be really worth trying. If it ends up being less stressful for you AND smoothing out their values, it could be great!

As for Nikita, she seems to have been high enough these last cycles that I would go back to 2ui for the time being.

 

For some cats, any change in food can cause numbers to rise. It doesn't seem to matter if the food is lower in carbs -- it takes their system a while to adjust to a change. (Cats are creatures of habit and any variation in their routine can have an effect on their BG levels, or at least some cats respond that way.)

@Stephanie & Quintus - are you sure you're not confusing carbs and calories? For a cat that's prone to developing ketones, calories are important. As you know, ketones develop due to infection/inflammation + not enough insulin + not enough calories.

I'm not convinced that you should increase Nikita's dose. The 1.75u brought the numbers down to 51 and then you changed the food. Maybe giving the food change another day to see if numbers are better may prove helpful.

 

@Stephanie & Quintus I can’t buy strips (or anything) for the moment, and I updated the charts

I find Dagobah was « lower » when I went back to 1ui... but I can be wrong!

She eats without restrictions, and when she asks she gets more (she loves chicken livers)
TID seems to be a good thing, the more I think about it, the more I wonder if it wouldn't be THE solution... I'll find a moment to talk about it with @Stacy & Asia (if you are around to make sure I get it well it's better!!)

Nikita has been sick less than a week ago, I would like to give her time to recover before to decide, but she gets lower soon after the shot so I was rather thinking about a reduction (but once again, I can be wrong) ...

 

I used the almost nature pouches, various flavours, I found the contributed to high BG in George, when I took them out of the picture he did better.

 

For now it's just a test, but I chose those whose carbs percentage was nul...

 

I think their labeling is not very accurate, I found some that claimed 0% carb yet in ingredients they had rice.
I also used the low carb ones, but that's what I noticed with George, it has been a while since I looked at their range, so it may have changed.
I did contact them about ingredients and carb content but they were not at all helpful, others have had a similar experience.

 

Dabogah's spreadsheet shows a possible furshot the night of the 25th. Today is just cycle 5 after the furshot. It takes time for the depot to build. You also increased the dose. Wait for the end of the 6th cycle after the fur shot to see what the numbers look like on 1.25 units.

I see you are still using R, but sometimes it's just listed in the Remarks part of the SS, and sometimes in the cells for the hours. It will help us if you could put all the times you use R in the cells for the hours.

The link to your last post here so we can easily see the history: http://www.felinediabetes.com/FDMB/threads/5-24-nikita-doesnt-eat-pmps334-2-307.196061/

 

I feel your frustration, it’s really hard to make sense of things when the numbers are all over the place. I would say Nikita has room for an increase except for the food change, I agree with Sienne, you have to wait it out a bit with new food in the picture. It’s always wise to make one change at a time so if something is off, there is an obvious culprit. Be it increasing the L dose, using R, trying new foods, changing food schedule, anything you alter, even if it seems small, can make a big difference and it needs time to make it clear what the difference is, if anything. Of course, everything is a bit of panic mode for Dagobah and ketones, so I understand why you don’t have the luxury of time with everything, but do what you can within reason to allow the changes to become clear.

I have a bad head cold at the moment so how I’m feeling combined with taking medicines that make me sleepy and not clear thinking, I can’t address this all right now that I want to because I want it to be well thought out and safe. You have a lot of good input here from others.

Mini food for thought: TID may be a solution, but I think it makes sense to explore all that you can dosing twice a day before adding another layer of complexity. I would try Levemir before TID and you already thought that would be a big change/starting over and was too much, TID would be a bigger change and would also be starting over in a sense. Even if it ultimately worked out well, you couldn’t make it work for you without understand the insulins better and how they work in your cats, regardless of dosing frequency, it just stands to confuse and frustrate you more ...and I don’t think you need more frustration on your plate, you are juggling quite a lot already.

Food is a good step, see how the food switch works out. Try to feed as consistently to a schedule as possible so that you can see where you feed, what you feed and how much you feed impacts the numbers. Give some thought to how you are using R. It is a great tool and no doubt has saved Dagobah from some ketones, but it also can create problems you didn’t have without it. Nikita does not need R at this time, so perhaps you can use Nikita as your “control” cat as you have a wider margin of error that you can play around with things and see how they work. Then try to apply that knowledge to Dagobah while you are playing the whack-a-mole ketone game with her. Look at the SS where R wasn’t in the picture and then where it is and see if you can gather some conclusions regarding the bounces and up down cycles with the use of R. A little goes a long way, you may be giving too much at one time and less would work better, try to keep a record of how much R you use and how much and how quickly a drop came as a result so that when you need it again, you can get the maximum benefit without sacrificing so much/starting a cycle of bouncing.

 

I'm a bit tired (tried to get a nap this afternoon but baby didn't want...) So I apologize if my English is worse than usual ;-)

@Wendy&Neko: Sometimes R is given by Dagobah's dad, and he doesn't want to understand how to fill in the chart (but I did the same mistakes before) and yet I didn't take time to make it clear and write his "datas"... But I'm glad he helps anyway ;-)

@Stacy & Asia, thanks for giving your time and opinion! I begin to lose patience (and hope) I stilll don't understand why they were great with lower doses at the beginning and now it's just a big mess.
I am really frustrated, and I think TID appeared like a "magic solution" I need more time to accept and understand more, but they don't have time...

So, if I understood correctly, You would keep 1,25u for Dagobah and 1,75u for Nikita until (at least) tomorrow PMPS? I Imagine I can try to be patient one more day!

 

Hmm I meant carbs, but maybe what I saw was calories, and it got mixed up in my memories? Not at all impossible.

I know I did see somewhere that some cats seemed to do better on slightly higher than zero or very low carbs, though (like, 5-6%). But that was not linked with ketones, in my memory. So maybe I remixed those two things?

 

To end the day on a good note: Dagobah gave me a beautiful and sunny 257 for PMPS
I think I'll get some real sleep tonight