Ricky getting worse but afraid to increase insulin

[PamJV]

Ricky's plantigrade gait keeps getting worse. If you all remember I changed from Alpha Trak meter to the Relion meter on 5/13/17 and with that change the numbers were much better. The numbers looked almost as good as they did on 2/1/17 ....the first time the vet had tested Ricky back before the Plantigrade Gait started. So at first I was relieved.

But the gait keeps getting worse. My vet had told me to increase by a whole unit up to 3 units but you all here said to go slower. So I did try 2.5, then I tried 3.0 then I tried 2.75. I had thought he looks better on 2.5. I don't think his numbers were any better on the higher dose. But his numbers are still all in the pink and yellow no matter what his dose is, which is bad, right? My vet had originally told me getting a nadir of 230 is perfectly fine if one doesn't plan on testing at home. I would be fine with that if Ricky looked good, but he doesn't.

I have tried the Young Again Zero Carb. Ricky still won't eat that. So now I have gotten a bag of Dr. Elsey's low carb and he does seem to like that one. So I am in turmoil wondering if the answer is to keep going up and up with the insulin, or should I start consulting with the specialty hospital? Maybe Ricky's HCM is a factor in the Plantigrade Gait, sense the blood pressure med slows his blood flow. Before this, I had vowed never to vet shop again because I did that with my last two ill cats and it resulted in spending a fortune and more agony for the cats and still they weren't saved.

thanks, Pam

 

[rhiannon and shadow (GA)]

I don't know how long Ricky has been on zobaline but it can take 3 months before one sees results.
Also the dose for the methyl b12 can be between 3 mg and 5 mg. You could increase the zobaline. Since it's a b vitamin, the body only takes what it needs and pees out the rest.

I gave 5 mg when we started having issues but I caught it the moment it started . Each cat is different.


I can tell you from watching another cat that would not eat wet food... that it can take a little more insulin to compensate for the dry food.
You just have to follow protocol as best you can and increase incrementally.
Dry food is metabolized differently so you can't do tight regulation with dry in the equation.
It makes everything unpredictable because it can stay in the system longer and it is partly to blame for those higher numbers.

Would he eat any of the freeze dried foods? I keep adding water to mine but my kitties prefer it dry. Sometimes they wait a while so it will dry up.
There are so many new freeze dried foods available now.

It's good that he's made it to the yellow floor.....that's a bit of progress.....

this is going to take patience on your part.....
I'm glad you are testing....

 

[Wendy&Neko]

Your last post here: http://www.felinediabetes.com/FDMB/threads/ricky-amps-371-2-353-4-266-6-298-9-316-pmps-238.178143 We include links to the previous posts, so people can follow the history easily.

Rhiannon makes an excellent suggetion about the freeze dried food. We have another member whose kitty won't eat wet but she did find a freeze dried food and now the kitty is getting close to remission. Freeze dried can be much lower carbs than dry. But since you are feeding dry, that means following the Start Low Go Slow Method for dosing. Hold the current dose for 7 days, then evaluate how the dose is doing. There is a good chance you will have to go up in dose. Getting Ricky to a better dose and close to regulation will help his neuropathy.

And don't worry about the size of dose. Ricky is still on a relatively small dose size. A cat needs however much insulin they need at a given time. Each cat is different. My Neko got up to 8.75 units as her highest dose, but was on around 0.25 units before she passed. Neko also had HCM but it didn't impact her blood sugar much. Heart conditions, or the meds they are on to treat it, can cause some insulin resistance. If it means a little bit more insulin, so be it.

 

[Sienne and Gabby (GA)]

Methyl B-12 (Zobaline) can only do so much on it's own. It's a two-pronged process of dealing with neuropathy. One part is the methyl B-12. The other part is getting the BG numbers in a better range. It's the high numbers that cause the neuropathy in the first place so they need to be taken into account.

I agree with Wendy. You need to be systematically increasing Ricky's dose until you start seeing numbers that fall into a normal (50 - 120 on a human meter) range. Please don't get fixated on the amount of insulin. A cat needs what a cat needs. The point being you want to get the numbers down both due to the neuropathy and to protect Ricky's kidneys. (FD is hard on the kidneys.)

 

[JanetNJ]

Reread the lantus protocol for dosing. 230 is not a good end goal. With a human meter you want to see a nadir of 50-120. Aim for 100 for now. Let's get this cat into good low blue numbers. You have not reached the ideal dose yet. Until you get her into lower numbers you aren't going to see improvement.

 

[Bobbie And Bubba]

Hey there, the only thing I would like to add is to please try and get some test in during the PM cycle. The +2 is a telling one as to how active the cycle could be but a before you go to bed test would be good too just to makes sure that Ricky isn't going to drop. There have been times when I got a +2 and it didn't appear to be an active cycle and later in the cycle Bubba took a dive. You want to catch those and to also know how low the insulin is taking him through the PM cycle. Otherwise the AMPS could be bounce and you don't want to be raising his insulin on a higher bounce number. That may or may not be the case with Ricky right now but, just wanted to throw that info out to you.

 

[PamJV]

I don't know how long Ricky has been on zobaline but it can take 3 months before one sees results.
Also the dose for the methyl b12 can be between 3 mg and 5 mg. You could increase the zobaline. Since it's a b vitamin, the body only takes what it needs and pees out the rest.

I gave 5 mg when we started having issues but I caught it the moment it started . Each cat is different.


I can tell you from watching another cat that would not eat wet food... that it can take a little more insulin to compensate for the dry food.
You just have to follow protocol as best you can and increase incrementally.
Dry food is metabolized differently so you can't do tight regulation with dry in the equation.
It makes everything unpredictable because it can stay in the system longer and it is partly to blame for those higher numbers.

Would he eat any of the freeze dried foods? I keep adding water to mine but my kitties prefer it dry. Sometimes they wait a while so it will dry up.
There are so many new freeze dried foods available now.

It's good that he's made it to the yellow floor.....that's a bit of progress.....

this is going to take patience on your part.....
I'm glad you are testing....

Rhiannon, I did start the Zobaline as soon as the Plantigrade gait became noticable. I don't think he will eat freeze dried. Right now the Dr. Elsey's dry food is only 5% carb so that should be pretty good I would think. I did try staying on a dose for 5 days and then increase if you see Ricky's chart. I was afraid with him on 3 units because I thought he seemed some weaker and the numbers did not get better. So I went back down to 2.5. It seems like the best numbers have been on 2.5, although these are not good numbers by the board's standards.

Pam

 

[PamJV]

Reread the lantus protocol for dosing. 230 is not a good end goal. With a human meter you want to see a nadir of 50-120. Aim for 100 for now. Let's get this cat into good low blue numbers. You have not reached the ideal dose yet. Until you get her into lower numbers you aren't going to see improvement.

Janet, My vet meant if one is not going to test at home then a nadir of 230 is a safe one because he says it would be worse to risk going hypo. In other words he says don't attempt such large doses as to take the cat down to a nadir of 100 if you are not planning to test every day sereral times a day. And initially it was never my intention to be testing at home. I had a cat years ago who I never tested and she did fine. I never thought it was going to be this difficult. But Ricky is a more complicated case due to him eating only dry food and also he has a heart condition. So I am in panic mode. I think I've tried several different doses and taking it higher doesn't seem to help.

Pam

 

[PamJV]

Hey there, the only thing I would like to add is to please try and get some test in during the PM cycle. The +2 is a telling one as to how active the cycle could be but a before you go to bed test would be good too just to makes sure that Ricky isn't going to drop. There have been times when I got a +2 and it didn't appear to be an active cycle and later in the cycle Bubba took a dive. You want to catch those and to also know how low the insulin is taking him through the PM cycle. Otherwise the AMPS could be bounce and you don't want to be raising his insulin on a higher bounce number. That may or may not be the case with Ricky right now but, just wanted to throw that info out to you.

Bobbie, Last night I did do a +2 test and it showed he went up about 13 points from the PMPS. I attribute that to the fact he ate a little after the shot. My morning shots have been around 10 am or even later, so it's hard to be testing PM cycles that much. Right now for example.....I can't find Ricky any where and I need to still give him the morning shot !
Pam

 

[PamJV]

Methyl B-12 (Zobaline) can only do so much on it's own. It's a two-pronged process of dealing with neuropathy. One part is the methyl B-12. The other part is getting the BG numbers in a better range. It's the high numbers that cause the neuropathy in the first place so they need to be taken into account.

I agree with Wendy. You need to be systematically increasing Ricky's dose until you start seeing numbers that fall into a normal (50 - 120 on a human meter) range. Please don't get fixated on the amount of insulin. A cat needs what a cat needs. The point being you want to get the numbers down both due to the neuropathy and to protect Ricky's kidneys. (FD is hard on the kidneys.)

Sienne, So you are saying instead of going back down when I saw his numbers worse on 3 units I should have just kept going higher? On the 3 units I thought his walking got worse. But maybe it's simply a trend of getting worse regardless.
Pam

 

[PamJV]

Your last post here: http://www.felinediabetes.com/FDMB/threads/ricky-amps-371-2-353-4-266-6-298-9-316-pmps-238.178143 We include links to the previous posts, so people can follow the history easily.

Rhiannon makes an excellent suggetion about the freeze dried food. We have another member whose kitty won't eat wet but she did find a freeze dried food and now the kitty is getting close to remission. Freeze dried can be much lower carbs than dry. But since you are feeding dry, that means following the Start Low Go Slow Method for dosing. Hold the current dose for 7 days, then evaluate how the dose is doing. There is a good chance you will have to go up in dose. Getting Ricky to a better dose and close to regulation will help his neuropathy.

And don't worry about the size of dose. Ricky is still on a relatively small dose size. A cat needs however much insulin they need at a given time. Each cat is different. My Neko got up to 8.75 units as her highest dose, but was on around 0.25 units before she passed. Neko also had HCM but it didn't impact her blood sugar much. Heart conditions, or the meds they are on to treat it, can cause some insulin resistance. If it means a little bit more insulin, so be it.

Wendy, Thanks for that info. So you mean 3 units is not considered a high dose? I am so confused. My vet was telling me if he doesn't do well on 3 units maybe we should try a different insulin. I wish I could see some improvement when I take the dose higher telling me that I'm going in the right direction. I would think a higher dose should show lower numbers.

Pam

 

[JanetNJ]

Janet, My vet meant if one is not going to test at home then a nadir of 230 is a safe one because he says it would be worse to risk going hypo. In other words he says don't attempt such large doses as to take the cat down to a nadir of 100 if you are not planning to test every day sereral times a day. And initially it was never my intention to be testing at home. I had a cat years ago who I never tested and she did fine. I never thought it was going to be this difficult. But Ricky is a more complicated case due to him eating only dry food and also he has a heart condition. So I am in panic mode. I think I've tried several different doses and taking it higher doesn't seem to help.

Pam

Have you started the elsley's food yet? If you just started it the numbers may come down a bit and the 2.5 may be ok.... But do curves because it doesn't look like it is enough.

I understood what you meant but I see you lowered your dose from 3 down to 2.75, then lowered again. I think you needed to go up, not down.... But let's see what happens with the new food. What were you feeding before?

 

[Bobbie And Bubba]

Bobbie, Last night I did do a +2 test and it showed he went up about 13 points from the PMPS. I attribute that to the fact he ate a little after the shot. My morning shots have been around 10 am or even later, so it's hard to be testing PM cycles that much. Right now for example.....I can't find Ricky any where and I need to still give him the morning shot !
Pam

Your shot times being 10 M/ 10 PM does make night time testing hard. Maybe if you get up in the middle of the night, you can grab a test. That was never a problem for me with my tiny bladder. If you don't usually have to get up in the middle of the night, a tall glass of water before you go to bed can help with that.

 

[PamJV]

Your shot times being 10 M/ 10 PM does make night time testing hard. Maybe if you get up in the middle of the night, you can grab a test. That was never a problem for me with my tiny bladder. If you don't usually have to get up in the middle of the night, a tall glass of water before you go to bed can help with that.

Bobbie, I just found Ricky and tested and his AMPS was 231 ! That's one of the lowest readings he's had, and by far the lowest AMPS reading. That comes out of the blue. It could be because I switched him to Dr. Elsey's Clean Protein yesterday and last night I took away the EVO dry. Given this I stuck with the 2.5 units and will test through out the day and see what happens.
Pam

 

[PamJV]

Have you started the elsley's food yet? If you just started it the numbers may come down a bit and the 2.5 may be ok.... But do curves because it doesn't look like it is enough.

I understood what you meant but I see you lowered your dose from 3 down to 2.75, then lowered again. I think you needed to go up, not down.... But let's see what happens with the new food. What were you feeding before?

Janet, I started the Dr. Elsey's food yesterday and last night took away his EVO dry. This morning his AMPS was 231 which was the lowest ever. So I stuck with the 2.5 units and will test during the day to see where this goes. Right now I don't know if the food has made the difference or it could be that Ricky simply had not eaten for a few hours before the test.

Yes, I had gone up to 3 units and then back down because physically he looked worse on 3 units as compared to 2.5 units. Plus his numbers did not improve on 3 units. I know I don't have a lot of testing to say the true effect of the 3 units.
Pam

 

[Sienne and Gabby (GA)]

The Dr. Elsey's chicken dry food is approximately 7% carb. Without getting the "as fed" numbers directly from the manufacturer, there's no way to know the actual carb content. 7%, though, is good. It is entirely possible that Ricky's AMPS is a response to a lower carb food. If you want to keep the dose where it is, then you need to hold the dose for a week unless Ricky's numbers drop below 90 (using SLGS). At the end of the week, you evaluate how effective the dose was. If numbers aren't where you want them, you increase the dose.

I wouldn't be comfortable concluding that numbers were worse on 3.0u. Ricky's AM cycle numbers weren't pretty but without knowing what was going on at night, you're basing a conclusion on half of the available data. It's possible that numbers are dropping lower during the PM cycle and you're seeing a bounce into higher numbers during the AM cycle. Many cats experience lower numbers at night so this scenario is entirely possible. Is there any way you can start getting at the bare minimum, one test during the PM cycle? If Ricky starts to respond to a lower carb food, the only way you will be able to make sure your kitty is safe is to get at least a before bed test every night.

 

[PamJV]

The Dr. Elsey's chicken dry food is approximately 7% carb. Without getting the "as fed" numbers directly from the manufacturer, there's no way to know the actual carb content. 7%, though, is good. It is entirely possible that Ricky's AMPS is a response to a lower carb food. If you want to keep the dose where it is, then you need to hold the dose for a week unless Ricky's numbers drop below 90 (using SLGS). At the end of the week, you evaluate how effective the dose was. If numbers aren't where you want them, you increase the dose.

I wouldn't be comfortable concluding that numbers were worse on 3.0u. Ricky's AM cycle numbers weren't pretty but without knowing what was going on at night, you're basing a conclusion on half of the available data. It's possible that numbers are dropping lower during the PM cycle and you're seeing a bounce into higher numbers during the AM cycle. Many cats experience lower numbers at night so this scenario is entirely possible. Is there any way you can start getting at the bare minimum, one test during the PM cycle? If Ricky starts to respond to a lower carb food, the only way you will be able to make sure your kitty is safe is to get at least a before bed test every night.

Sienne, Dr Elsey's site claims the carb content is 5%. What ever it is it would be lower in carb than EVO or DM. I don't think Ricky would experience lower numbers at night since that's when he eats more. Last night I did a +2 test in the PM and his BG went up 13 points from the PMPS. I realize compared to all of you I have little data to draw conclusions. I'm trying to work fast because it's hard to see him with the neuropathy.

I was excited seeing Ricky's AMPS at 231 this morning, but now at +2 he's up to 279. He ate after the morning shot.....but not a lot. So I am guessing the 2.5 units isn't enough to counteract his rises in BG when he eats.

One question is that if you all say I must stay on a dose for a week then why bother testing several times a day if it won't affect the dose ? Is this only to detect if he drops below 80? I don't see that happening here.

One +6 test in the PM would be about 4am. Hard to say if I could even find him in the dark house at that time. I can try.

Pam

 

[Sienne and Gabby (GA)]

One question is that if you all say I must stay on a dose for a week then why bother testing several times a day if it won't affect the dose ? Is this only to detect if he drops below 80? I don't see that happening here.

The issue is that if you don't test, you don't know whether the dose is effecting the numbers. I'd have to plow through the first couple of years on Gabby's SS but there was a day where her AMPS was in the 400s. By mid-cycle she was in the 40s and she bounced back up into the 400s by PMPS. If I hadn't caught the mid-cycle numbers, I would have been increasing her dose rather then reducing her dose based on the data.

You hold the dose for a week UNLESS the numbers drop below 90 (if using SLGS). Don't presume it won't happen. Our cats are very unpredictable. Because bouncing is so prevalent in newly diagnosed and/or unregulated kitties, testing is the only way to keep your cat safe. The more data you collect, especially early on, the better able you are to know when onset and nadir fall, how much duration you're getting from the insulin, and basically how your cat responds to Lantus. While the dosing approaches are written with the idea that nadir with Lantus is around +6 (give or take), there can actually be a much wider variation. Gabby's nadir was typically at around +3 or +4, except when it wasn't. Because she usually had an early nadir, I set her shot times to accommodate my work schedule -- I tested at 5:00 which allowed me to be home for several hours in the AM so I could see if her numbers were dropping and if I needed to intervene with food. But, that was Gabby. Every cat is different (ECID). You need to know how Ricky responds. This will help you to not feel like you're chained home all the time monitoring your kitty. Testing also insures that Ricky is safe. I would love to tell you that there's never been a cat that was put in harms way by a caregiver who thought the testaholics (myself included) on this board were feeding them a line of BS. While it has only very rarely happened here, it has happened more times than I care to see on the the Facebook page of the board. I think Baxter's story is pinned somewhere on the page. Baxter suffered from a severe hypoglycemic episode and nearly died because the caregiver's vet told her she didn't need to test and she probably thought people on the FB page were being dramatic. Needless to say, the caregiver is now the poster mom for home testing.

On a happier note, there are also times when you hit on your cat's "good" dose and everything snaps into place. A SS that is largely in the yellows or above, suddenly turns all blue and green. Cats can and do run down the dosing ladder quickly in some cases. Again, getting your cat comfortable with testing makes some of these kind of anxious times much less of an ordeal for both you and your cat.

Ultimately, though, how you test is up to you. I like data and Gabby was a challenging cat to manage. As a result, I had lots and lots of data and despite some forays into low numbers, I knew I had the confidence to manage her cycles.

 

[Wendy&Neko]

So you mean 3 units is not considered a high dose?

No, three units is not a high dose. We have many kitties here above three units in dose. It is not the fault of the type of insulin, but rather what the cat needs as each cat really is different.

 

[MélanieW]

My cat Noah won't eat wet food AT ALL. After almost six months of trying he still won't eat it. I was able to switch my non-FD kitty right away. My non-FD kitty has access to wet food all day so you would think Noah would get hungry and try to eat some... but NO... not even when I put Temptations in it. I didn't think Noah would like freeze-dried raw, but he did and that has really help manage his diabetes. Might be worth a try as Primal nuggets are really low carbs...

Noah got to 4 units before we saw any blue. Got to 4.25 units before green. Before that, all we saw was a sea of purple with some yellow. I know how hard it is to keep increasing the dose, but you'll hit the magic dose and you'll see better numbers. Hang in there!

Come on Ricky work the juice!!!

 

[PamJV]

The issue is that if you don't test, you don't know whether the dose is effecting the numbers. I'd have to plow through the first couple of years on Gabby's SS but there was a day where her AMPS was in the 400s. By mid-cycle she was in the 40s and she bounced back up into the 400s by PMPS. If I hadn't caught the mid-cycle numbers, I would have been increasing her dose rather then reducing her dose based on the data.

There have been a few times when I tested Ricky every two hours or just at pre shot, and the mid cycle. He's never had a reading below 229 ! I can see how you'd get motivated to test if your cat was showing some low numbers. So far it's not happening with Ricky and I'm anxious to break out of this mold and see some improvement. If I could just see his walk improve I'd be encouraged.
Pam

 

[PamJV]

My cat Noah won't eat wet food AT ALL. After almost six months of trying he still won't eat it. I was able to switch my non-FD kitty right away. My non-FD kitty has access to wet food all day so you would think Noah would get hungry and try to eat some... but NO... not even when I put Temptations in it. I didn't think Noah would like freeze-dried raw, but he did and that has really help manage his diabetes. Might be worth a try as Primal nuggets are really low carbs...

Noah got to 4 units before we saw any blue. Got to 4.25 units before green. Before that, all we saw was a sea of purple with some yellow. I know how hard it is to keep increasing the dose, but you'll hit the magic dose and you'll see better numbers. Hang in there!

Come on Ricky work the juice!!!

Mélanie, I will look for the primal nuggets and give it a try. OK I see what you are saying. I got scared because I thought I saw him getting more wobbly when I went up to 3 units. But maybe that was just just the diabetes itself not being controlled and it wasn't particular to whether he was on 3 units or 2.5 units. Maybe he just has natural fluctuations.

How does one know if the issue is the insulin itself and that one should try a different one?
Pam

 

[MélanieW]

Last time I was at the store they had small free samples of the Primal nuggets in turkey and chicken and salmon. Maybe you could find the samples at a store near you. This way you could try before buying it. Food has been a BIG part of managing Noah's diabetes and getting rid of the dry food meant we could do tight regulation. I wanted to get him in good numbers as fast as possible. However, I still remember how defeated I felt at first every time I would increase the dose, but he needed what he needed.

With Noah I was seeing so many symptoms before we got the diabetes under control. And the flat numbers were just the worst. I felt like I was seeing the same numbers over and over again. But now I'm a testaholic and I probably need an intervention

As far as trying a new insulin, I think they recommend giving an insulin at least six months before switching.

 

[Wendy&Neko]

I wish I could see some improvement when I take the dose higher telling me that I'm going in the right direction. I would think a higher dose should show lower numbers

It really helps if you remind yourself that insulin is a hormone, not a drug. Adding a bit more insulin often doesn't show a corresponding improvement in numbers. Many cats stay high and flat through a bunch on increases before they finally hit that breakthrough dose. Take a look at Rudy's spreadsheet. He got up to five units with only a little blue at 4.75 units before the light bulb went off, then he started racing down the dosing scale.

You haven't given Lantus a fair shake yet. Stick to the SLGS guidelines, hold 7 days, evaluate the dose, then increase if needed. You WILL get there, you just need to be patient.

 

[Bobbie And Bubba]

I was excited seeing Ricky's AMPS at 231 this morning, but now at +2 he's up to 279.

That rise at +2 is actually a normal food hike. If at the +2 the number would be the same as the pre shot or lower , then it would be could be an active cycle and more testing would be required.

 

[PamJV]

It really helps if you remind yourself that insulin is a hormone, not a drug. Adding a bit more insulin often doesn't show a corresponding improvement in numbers. Many cats stay high and flat through a bunch on increases before they finally hit that breakthrough dose. Take a look at Rudy's spreadsheet. He got up to five units with only a little blue at 4.75 units before the light bulb went off, then he started racing down the dosing scale.

You haven't given Lantus a fair shake yet. Stick to the SLGS guidelines, hold 7 days, evaluate the dose, then increase if needed. You WILL get there, you just need to be patient.

Wendy, Holding at 2.5 for 5 days right now is kind of hard, since Ricky was already on this dose before for 5 days, and then I tried 2.75 for 3 days then went back down to 2.5 again. Looking at Rudy's SS I don't understand what was going on there. It doesn't appear you were holding doses for 5 days. I can't see what helped you know when to lower doses.

Pam

 

[PamJV]

That rise at +2 is actually a normal food hike. If at the +2 the number would be the same as the pre shot or lower , then it would be could be an active cycle and more testing would be required.

Bobbie, And then Ricky continued to rise the rest of the day. So my big excitement did not pan out. I realize now that when my vet was telling me that what they want to see is a perfect bell curve with the nadir at about the +6 hour mark......this is possible at the vet office where the cat doesn't eat. However, at home Ricky nibbles and he's not getting a bell curve.
Pam

 

[Bobbie And Bubba]

If you can get the test without food influence 2 hours before the test , it will be more accurate. It's hard to have a free feeder and to get regulation.

 

[Wendy&Neko]

People who follow the Tight Regulation protocol for dosing can increase as often as every three days. If you are feeding dry food, then the Start Low Go Slow method is what is used for dosing. Which means holding for 7 days. With andepot insulin like Lantus, you have to be patient and hold the dose to let the depot build.

As for bell curves, I think the majority of cats do NOT have their nadir at +6. And it can also vary from cyclemto cycle, though there is usually a typical nadir time. That's why we recommend testing enough so that you can find what your cat's onset, nadir, and duration are.

 

[PamJV]

If you can get the test without food influence 2 hours before the test , it will be more accurate. It's hard to have a free feeder and to get regulation.

Bobbie, I am getting the lowest reading in the morning. That's when I have to wake Ricky up to test him. I assume he probably hasn't eaten for two hours since this is his lowest reading. This morning his reading was 192 ! That was his first blue number. If today is like yesterday then he gradually rises all day and curves down toward the end of the 12 hours. So he has an inverted Bell Curve !
Pam

 

[Mandy & Rex (GA)]

Wendy, Holding at 2.5 for 5 days right now is kind of hard, since Ricky was already on this dose before for 5 days, and then I tried 2.75 for 3 days then went back down to 2.5 again. Looking at Rudy's SS I don't understand what was going on there. It doesn't appear you were holding doses for 5 days. I can't see what helped you know when to lower doses.

Hi, I just want to chime in on this question you had. You hold the dose if you do not see a number under 90 with SLGS for 7 days. With Rudy, he would go lower than 90, which earns a reduction of 0.25.

Rex was another cat that had numbers mostly in reds and a few pinks until he got to 3 units and then something switched on and he went back down the ladder. You can see his SS in my signature.

Hang in there ... it will all work out in the end.

 

[Sienne and Gabby (GA)]

One thought to throw out there... Ricky may be exceedingly carb sensitive. Some cats are. Jill's Alex could jump up 30 or more points from a piece of raw chicken (zero carbs).

First, a curve is not a bell curve -- it's a reverse bell curve. With Lantus, the ideal "curve" is flat. Because Lantus has a longer duration due to its being a depot type of insulin, ultimately, the curve flattens out. Also, as others have noted, do not presume your cat's lowest point in the cycle will be at the midpoint. Some cats have either early or late nadirs. There are some cats on Lantus who's nadir is as late as +10 or +11. (This is a more typical pattern with Levemir.)

 

[PamJV]

People who follow the Tight Regulation protocol for dosing can increase as often as every three days. If you are feeding dry food, then the Start Low Go Slow method is what is used for dosing. Which means holding for 7 days. With andepot insulin like Lantus, you have to be patient and hold the dose to let the depot build.

As for bell curves, I think the majority of cats do NOT have their nadir at +6. And it can also vary from cyclemto cycle, though there is usually a typical nadir time. That's why we recommend testing enough so that you can find what your cat's onset, nadir, and duration are.

Wendy, OK I see what you mean. I have thought Ricky is not getting much of a curve. Like yesterday the curve was lowest at the preshot times and up when it should have been the nadir. This morning at preshot his reading was 192. Now I really wonder what is going on during the night.

Pam

 

[PamJV]

Hi, I just want to chime in on this question you had. You hold the dose if you do not see a number under 90 with SLGS for 7 days. With Rudy, he would go lower than 90, which earns a reduction of 0.25.

Rex was another cat that had numbers mostly in reds and a few pinks until he got to 3 units and then something switched on and he went back down the ladder. You can see his SS in my signature.

Hang in there ... it will all work out in the end.

Mandy, I think Rudy also had increases after a dose that was held for only 3 days. But now I understand that is OK on TR. I am totally confused. Last night I tried a 2.75 unit dose and this morning his AMPS was 192 which is his lowest reading so far. But yesterday he had AMPS reading of 231 and then the BG climbed all day and then dropped to 304 at PMPS. I will try to test as much as I can today.
Pam

 

[PamJV]

One thought to throw out there... Ricky may be exceedingly carb sensitive. Some cats are. Jill's Alex could jump up 30 or more points from a piece of raw chicken (zero carbs).

First, a curve is not a bell curve -- it's a reverse bell curve. With Lantus, the ideal "curve" is flat. Because Lantus has a longer duration due to its being a depot type of insulin, ultimately, the curve flattens out. Also, as others have noted, do not presume your cat's lowest point in the cycle will be at the midpoint. Some cats have either early or late nadirs. There are some cats on Lantus who's nadir is as late as +10 or +11. (This is a more typical pattern with Levemir.)

Sienne, The thing is when Ricky's first glucose curve was done at the vet office he had a perfect bell curve and the vet hammered me with the fact that this is what we want .... a perfect bell curve. But now I realize that a big difference was that Ricky didn't eat at all the whole time at the vet. So there was no food influence. At home his curve has been either flat or inverted. I'm watching closely today. AMPS = 192, +2 (185). I also checked his weight and see that he gained and is now at 16.9 lbs
Pam

 

[Bobbie And Bubba]

Hey Pam, with the +2 today being lower than the preshot, it would be good for you to get some more test in as it could be an active cycle. It will take some more testing and some at night ( I know you said your times are 10 am and 10pm) but if you could set your alarm to get a test in around +5-7 to see how low the Lantus is taking him. Otherwise you won't know if the AM cycle is going higher as the day goes on due to a bounce . Another really good test for you to get in would be the +10 and +11 . That will tell you if he is rising or falling by the time you do the Pre shot test.

Like some have said, some cats do nadir late. Bubba was one of them. His lowest number in the cycle was both the AM and the PM pre shot. That did change the last time he was back on the juice last Sept - Feb. He then changed his nadir to almost consistently mid cycle. But, they change their nadirs at any given time. ( they don't read the rule book)

 

[PamJV]

Bobbie, I definitely will try to test today every two hours if I can. As for PM cycle, I will try. I could stay up until 3am. The weird thing was that Ricky didn't go eat after his shot. He wanted to be brushed. I brought him a handful of food because I was afraid of him going too low with no food. He ate the handful. It's not like him to ignore food bowls in the morning.

 

[PamJV]

Hey Pam, with the +2 today being lower than the preshot, it would be good for you to get some more test in as it could be an active cycle.

Bobbie, +4 (161) so it is an active cycle. Watching and hoping he doesn't go too low.

Pam

 

[Bobbie And Bubba]

Bobbie, +4 (161) so it is an active cycle. Watching and hoping he doesn't go too low.

Pam

He is nice and safe right now. He is finally starting to work the insulin. If he goes below 90 you will earn a reduction with SLGS method ( which is what you need to follow since he only eats dry food)

If you need to steer lower numbers if he goes below 50 or if starts a cycle dropping to quickly early on, , we feed higher carb wet food because it acts faster than dry food. If he absolutely won't eat wet food, you will have to steer with little honey, Karo syrup or maple syrup. I am just throwing that out to you now so you will be prepared. It doesn't look like you have ever had to steer up lower numbers before.

Did you start the Dr. Elsey's food yet?

 

[PamJV]

He is nice and safe right now. He is finally starting to work the insulin. If he goes below 90 you will earn a reduction with SLGS method ( which is what you need to follow since he only eats dry food)

If you need to steer lower numbers if he goes below 50 or if starts a cycle dropping to quickly early on, , we feed higher carb wet food because it acts faster than dry food. If he absolutely won't eat wet food, you will have to steer with little honey, Karo syrup or maple syrup. I am just throwing that out to you now so you will be prepared. It doesn't look like you have ever had to steer up lower numbers before.

Did you start the Dr. Elsey's food yet?

Bobbie, Missed the +6 time, as I was out. Just measured +7 (275). So far today he had AMPS (192), +2 (185), +4 (161), +7 (275). That seems like a rapid increase between the 4 hour and 7 hour mark. Do you think that was just a natural rise from eating? Or could he have had a bounce that I didn't detect because I couldn't measure at the 6 hour mark?

Yes, I started the Dr. Elsey's food two days ago.

Pam

 

[Bobbie And Bubba]

He could have gone a bit lower but, don't think too much. Today's rise could be from hitting blues that he is not used and he is starting a bounce and could be from food if he had just eaten.

The lower numbers today could be from lowering the carb count with the Dr. Elsey so I am so glad that you are monitoring. He is looking good. Now, the bouncing is where you need to put on patience pants because the bounce last 6 days or 3 cycles.

 

[PamJV]

He could have gone a bit lower but, don't think too much. Today's rise could be from hitting blues that he is not used and he is starting a bounce and could be from food if he had just eaten.

To update: Monday's numbers were AMPS (192), +2(185), +4(161), +7 (275), PMPS (275), +4 (243)

This Tuesday morning, I saw Ricky eating for about 10 minutes at 8am. He seemed very happy and even played with toys and attacked his brother. I have not seen that for months. Then I tested him at 10am and AMPS (295). So that's a big difference from yesterday's AMPS. I can only guess that Monday AM he must have not eaten as much. I am in the process of trying to get his shot times earlier.

Pam

 

[Bobbie And Bubba]

Hi Pam, looks like he is bouncing still from the blues yesterday. If you want to change his shot time earlier, just remember that an earlier shot acts like an increase. We usually say to move the times around either way to do 15 minutes a cycle or 30 minutes a day . In 4 days time you could have his shot time moved to 8 AM and 8 PM. That will be a big help for you for the PM cycle to get at least a +2 to see how active it will be and a before you go to bed test in .

So glad to hear that he is playing with his brother. It always does the heart good to see them resuming activities pre Feline Diabetes.

Now, for some housekeeping. We start a new thread each day with kitties name and date and AMBG # Then copy and paste the URL of the previous days thread and link it in the body of the new day. That way the threads don't get too long for people to scroll through to see what transpired the day before.