? Over two years in and still bouncing - any ideas?

My New Year's Resolution this year was to figure out how to get Winnie's BGs under control. There are WAY too many reds and pinks in her spreadsheet and when I look at other members' spreadsheets and see all their lovely blues and dark greens, it's even more dismaying. She seems to bounce no matter what I do. I have tried leaving LC food out for her over night so that she doesn't drop too much and then bounce sky high. I have tried feeding her MC food (14%) when her PS numbers are a bit lower than usual, with the same hope. And it seems that sometimes these measures help and sometimes they make no difference at all. I changed from 1.0 unit to 0.5 units in early Jan. and I think we're doing better at the lower dose - because at least now there are SOME blues and greens - but those pinks and reds keep popping up too. Meanwhile, she eats well, plays, has a beautiful coat, isn't overly thirsty, walks and jumps normally, and seems entirely happy, but I worry about what all this bouncing means for her longer-term prognosis. Advice and/or encouragement would be much appreciated.

 

I’m trying to open Winnie’s spreadsheet but am encountering an error. I will try again on my desktop when I can get back to the office! Can everyone else see it?

 

Thanks for letting me know. I've probably done something wrong. I'll see if I can fix it.

 

I can’t access it either, it looks like it’s not shared or viewable to all perhaps?

 

Could you please try the link below?

 

The link works but not when you click on the Winnie’s spreadsheet but when you click in the signature part.

 

Thank-you. I'll keep working on it.

 

I tried again. It works in the signature when I click on “Winnie’s Mom”.

 

That's strange. Ironic that I say right after that that I'm technologically challenged.

 

Ok. Tell me more about:

- diet: what meals, exactly? Any snacks?
- timing: are injections 12 hours apart or differen?
- injection location/ rotation?
- labwork? What were the latest results?

 

I feed her a small amount of Friskies paté 5 times a day - 7:00 a.m., noon, mid-aft, 7:00 p.m. and then 9-ish. If she eats all of the 9:00 meal, I have recently starting putting a bit more out for her over night. She doesn't get any treats except when I test her; after each test I give her 1/2 a Temptations. (I have tried dozens of different kinds of LC treats, dried fish, etc. and she won't touch any of them.)
Injections are 12 hours apart - sometimes an hour on either side but never more than that.
I wasn't rotating the injection site until Jan. 13/18. Since then, I do it in a different spot every time.
No blood work recently except for a fructosamine test on Jan. 29 which was 447.

 

The last numbers on the spreadsheet are from 4/17. Do you have a current SS?

 

Yes, I have one that goes up to today but obviously that's not what's coming up. Not sure why. it may take me a while to figure out how to make it available. I'll repost when I've done that. Thanks!

 

I think you might be reading the SS wrong. The one she has posted has numbers through today but the World SS is not dated. I’m working on this for Kerrie.

 

Hi Kerrie,
I am pretty new here but want to ask a few questions. I know you said you feed small amounts to the cat 5 times a day, and I was wondering if you could quantify that? Does she usually eat the same amount every day, or does it vary day to day?

Also, as far as the treats go, is it possible to cut them out just to see if it makes any difference? (If my calculations are correct, 1/2 a chicken temptations treat is abou 1.4 g carb .)

Again, I hope someone more experienced will reply, but I’m trying to get a better picture of what your cat is eating.

Ana

 

Hi Kerrie, welcome to my world. Going on 3 years yet i know why mine isnt regulated yet. My boy had a rough year last year plus I was giving wrong food for too long. So now my boy is dka/ketone prone, has liver issues and had cystitis over last summer. My boy is better now but still hard to do. He has been like a rubber band for awhile. Feel free to look at his SS. I try to put alot of info as i tried new stuff.
Anyway, i looked at ur SS. I am thinking this could be possible.
On days when she is in red its either in AM or after a drop in greens. So she could be going lower at night plus having some dawn phenomenon.
My boy has both of these. I started testing when i got up to pick up dishes and was surprised he was going lower at night.

So your girl could do the same. I would try to have same amount of food in day cycle as in night cycle. Use an auto feeder if u can. And grab some early am tests.
I found the balance of steady amounts and steady carbs has worked so far.
His bouncing started getting not as high and didnt last as long but it took awhile. Trying to get them to surf in 100s helps to train their bodies that those numbers are good.
I hope that helped. I think i may have lost my train of thought while typing as its hard to look back on a cell showing me only 3 lines of what I wrote already.. lol.
If i missed something, just ask...lol.
Hope I helped a little.
Hugs!

 

Thank-you for all the above posts and I apologize for not replying sooner. I thought I would be alerted when new posts appeared and so thought that none had. Anyway, I am doing a BG "curve" (such as it is) today and Marje has straightened out all my SS woes (thank-you!) so I will start a new post, with up-to-date numbers, tomorrow and hope that all of you will repost - with all your extremely helpful observations - then.

 

Hi Ana - Thanks for replying to my post. On the subject of Temptations, I found the following thread on FDMB - http://www.felinediabetes.com/FDMB/threads/temptations-treats.84752/. It suggests 0.5 grams of carb per treat. I'm hoping that's correct. Maybe it depends on the type. Anyway, thought you'd be interested. Also, thanks for the comment re amounts she eats. That may be a factor. It DOES vary a bit from day to day - 1 tin (of Friskies paté) some days; 1 1/3 tins others - but usually spread out in fairly equal percentages across the day.

 

Happened to see your thread and thought I would say hello from a fellow Canadian (Winnipeg, Manitoba)

I have a VERY bouncy girl as well....coming up 2 years since she was diagnosed If she sees a lower green number she bounces through the roof for at least the next cycle if not a few cycles. The one thing I see is that you have gone back to SLGS and are using a pet meter. The dose reduction for SLGS is a reading of 5mmol (90US) on a human meter. Pet meters read higher, so 5 is definitely a reduction point with a pet meter when following SLGS. Jan. 30 Winnie dropped down to 3 mmol which would have called for a reduction even with TR., but you held the same dose. Jan 14 she hit a VERY scary 1 but again you held the same dose.

From the SLGS sticky:

"
Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit

• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose

• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases.'

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

It may be a good idea to take reductions when Winnie hits the glucose levels as described above and see if that helps with the bouncing.

 

I have a couple of thoughts...

First, I think you are holding doses for way too long. Holding a dose that isn't getting Winnie into normal range numbers is likely to allow glucose toxicity to develop. Basically, this means that Winnie's body likes being in higher numbers. It also means she's more likely to bounce. I would urge you to evaluate Winnie's dose every week since you're following SLGS. If the majority of the nadirs aren't where you want them to be, then increase the dose. I'd also encourage you to not skip shots if Winnie is in blue numbers at pre-shot times. You may need to get more comfortable with shooting lower numbers so you don't end up skipping. Usually, there are people around and we can help.

In order to deal with the bounciness, whether it's due to glucose toxicity or not, one option is to use food to bump up numbers so you're not giving a dose reduction. At the same time, you want to increase the dose so you're essentially forcing the numbers to come down but bumping them up with food. This should allow you to see more blue and green. This may take more monitoring than you want to do. You get enough tests during the AM cycle but I would worry about using this strategy if you can't test more at night.

I also agree with Mary Ann, You need to take dose reductions when they are warranted.

Is there any possibility that you can get a before bed test every night? Many cats like to drop into lower ranges during the PM cycle. Getting a consistent test will inform you as to whether Winnie is dropping lower at night and bouncing back up during the day.

 

So, if I get a nadir below 90US (or 5 mmol) I decrease the dose by 0.25 units - but for what length of time do I keep her on that dose? (The Jan. 14 event was indeed scary; I don't know WHAT I was thinking to have given her 0.5 when her AMPS was 113!) I am really leary of increasing the dose for 2 reasons - one is that she does go into those scary green numbers on occasion and even when I'm around I may not catch them; the other is that I travel a lot and my cat sitter can't test, so I need to find a dose that walks a fine line between getting the high BGs down, while preventing going into those scary low levels.

 

After a reduction or an increase the suggested approach is to hold the dose for a week, as long as the numbers do not drop below 5mmol (90 US). If you are not around for periods of time and the catsitter can't test then doing a reduced dose during those times would be prudent. IF it is time for an increase try to match it with a time when you will be available to test on a regular basis. Also if at all possible try to get a test or two in after the PM dose to see if Winnie is dropping in the evening.


The guidelines for reductions, increases and holding a dose are all listed in the sticky for SLGS:

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

"
Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit

• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose

• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases.'"

 

Thanks for that! I was interested to see in your signature that you switched from Lantus to Levemir. What was the reason for that?

 

My first FD kitty who passed last year, was more sensitive to the "sting" of Lantus. When I changed him to Levemir he did not flinch from the shot the way he did with Lantus. A lot of people with high dose kitties find that there is less reaction from the shot when using Levemir. They are both long acting insulins but the chemical make-up and mode of delivery is different. On the other hand many members use Lantus with no problem at all. With my current FD kitty I used Levemir since that is what her brother was on and I just continued with it.

 

We are kind of in the same boat with Gandalf. We are over two years in and he still likes to bounce. I recognize the feeling, I sometimes find it really hard not to be jealous of the kitties that quickly go into remission or are easily regulated. But then I look at my baby boy and realize that he is doing just fine, he eats well, he plays, and he is happy. I think we have finally just accepted the fact that he will not go into remission, and he will probably never be well regulated either. And that is fine as long as he keep feeling well.

We felt we did everything just right after diagnosis, changed to a raw food diet, started testing at home and tried to stay on top of dose changes. The most annoying thing with Gandalf is that lately the dose reductions tend not to stick if we follow any of the protocols... We try our own method at the moment but he is still bouncing. It might seem like we are able to test a lot, but it takes a lot of effort to keep that up and we are very lucky that we are students with flexible schedules. I worry what will happen when we start to work... A regulated cat with predictable cycles would be the dream for that day.

I don't have any tips or solutions for you, just wanted to say you are not alone. The best advice I can give you is to "ignore" other's success stories, focus less on BG values (it is just a value) and more on how your kitty is actually feeling. Then it might be a bit easier to try and follow and work with a protocol and the helpful tips from others here, even if they do not end up helping with the bouncing.

 

Not sure if someone said this already as i am still reading your thread. You sitter needs to learn to test. You can teach her and have her do it with you there then when your not home to get the cat uses to letting her test while ur not home.
All petsitters should know how to do this and instructions for hypo too.
I am a petsitter and know many of them. If i can learn to test she can too!!