any reason for no lower reading at the nadir???

looking at many a spreadsheet and reading up on lantus.everyone seems to get a lower reading at the nadir.my bailey (bails) seems to be pretty consistent throughout.is that normal?
also its been weeks since hes been completely himself.is that part of diabetes? ive checked for ketones.(theres no sign) his kidneys and liver and waterworks were checked 3 weeks ago.they were also ok.theyre being checked again sat when he has his fructosimine checked.do high readings make them feel poorly?

Hi Anna;

I believe it's called 'surfing' whereas the numbers are all constant...........Davidson does this too and sometimes doesn't drop much or at all. Most cats are not themselves since they know they are sick or at least not 100%, and same as human - when we don't feel well we want to sleep more, don't want to play or take showers...........cats will groom less, sleep more and certainly won't be like their old selves. Don't worry - once the insulin gets regulated they will come back and be themselves within time. Yes, high numbers will make them lethargic, sleepy, and with lots of peeing most of the them will drink lots to replace the liquids...........that's why it's important to get lots of blood tests in so that you can see where he's at and can then start to tell when he is not feeling well - the numbers will be higher.

Davidson never played like he used to and all he did was eat and sleep and pee.........now that he is in the green and numbers are low or normal, all he does is play and stays up with me most of the day like he used to before his DX. As I was told - patience, he will get there...........just have to give it time.

Shawna

Hi Anna!

It'd be really helpful if you could get some other tests in on Bailey, especially in the PM cycle. We look at our spreadsheets kind of like a puzzle. When all we have are the "side" pieces, it's hard to see the whole picture, so it'll be best if you could get some tests in at other times during the AM cycle, and at LEAST a "before bed" test on the PM cycle.

Nadir's aren't always right at +6..they can move from cycle to cycle, and not all cats nadir in the middle part of the cycle.

Can you get some tests at other times other than just +6 during the day and some before bed tests on the PM cycle? It's also important to get those tests at night because most cats go lower at night, and he could be going low and then bouncing high by the next morning.

really his before bed test is the am shot as its 1am.with this In mind as much as I loves him I honestly couldnt get up again in the night as im in work the next day.sometimes 4am(where I test before I go) or 7am and again I test before I go.i don't want to be a big tired mess as I have to be well to deal with it all.its so hard.
I just so hope I get my boy back once regulated.im honestly trying my best.with having to work 42 hours a week and living alone with my boy.its all down to me.
hes definitely not peeing as much (2/3 times a day.4 max on a bad day) but yes sleeping,feeding is pretty much how it goes.i miss him coming to me for snuggles as most nights hed come for cuddles and sleep on me or snuggle against me he now prefers to sleep alone which worries me.its all a learning curve that im prepared for to get my little guy right!!
I could tell by his spread sheet he goes lower at night because the am test is lower quite a few times.even though its pre shot.he was on 6 units of canuslin before this and is a long big cat.not fat by any means but big.

Hi there Anna

The nadir will not necessarily be at +6; every cat is different (ECID). Additionally, your kittys nadir can and will likely change along the path to regulation.

When you step back a bit and look at Baileys ss, there are a lot of 'wide open spaces' . Before any further increases in dose I encourage you to make an effort to fill in some of those spaces - for both the AM and PM cycles. Many kitties run lower on the overnight and I suspect Bailey is one of them. This may account for the high AMPS numbers.

If you can manage, try to sprinkle some tests throughout by staggering your test times-
for example a +2 and +9 on the PM cycle tonight and in the AM tomorrow a +4 and +7 etc. In this way you will get a better sense of what is really going on and may be a real eye opener. Additionally, whenever you have a day when your schedule permits it, testing every 2, 3 or even 4 hours during a cycle would be great.

BTW, I noticed remarks on the ss regarding dry food - have you recently transitioned him to 100% wet low carb food? If so congratulations - it's the best foundation on which to build your treatment plan. It can have a profound effect on Baileys insulin needs - for the better - another reason to get some more tests in before increasing the dose.

Hang there - and hang in here. It's the best place you and Bailey can be. We have all been where you are

I know how you feel, Anne. It's just me here earning the rent, utilities, and cat food, here, too.
I am a little worried about how fast you have increased Bailey's dose, and cats do tend to go lower during the night and since Lantus dosing is based on the lowest point in a cycle, I am concerned that that could be when he is having his lowest numbers.

I don't know if you can do this, but I go to sleep as early as I can, so that I can get by with a wake up in the middle of the night to test. And, I have learned to sleep in on weekends whenever I can.

hi Anna!

There is an odd phenomenon that happens with insulin in diabetic cats - sometimes too much insulin can cause high numbers. It can look just like not-enough insulin. The cat's body is fighting to sustain itself against the insulin and is releasing stored sugars and hormones to keep the cat's blood sugar up.

Looking at what's happened in the past 10 days or so:

2/24 Bailey didn't have any dry food - i think his first day without any.
2/25 amps was 70 - AWESOME! looks like his body was responding to the dry food carbs going away. You waited one hour, then gave 1unit of insulin.

2/25 pmps was 520 - he bounced. you went back to his previous dose of 2.25u. The bounce was caused by his liver reacting to the lower numbers that he wasn't used to. it didn't mean he needed more insulin. See the description below of that.

2/26 amps 394, dose increased to 2.75

now he's increased to 3.25 and he's basically been high since 2/25.

Here is a post explaining why we sometimes see high numbers that are not caused by a cat needing more insulin: New Dose Wonkiness and Bouncing. The TR Protocol is pretty specific on how long we wait inbetween dose increases and what the increment of the increase should be.

I think he's very likely high from getting too much insulin, not from too little. When the dry food carbs went away, he got down to 70. I'd like to suggest that you reduce his dose at his next shot. I think i would go to 1.5u and hold it for at least 6 cycles to let things settle and see what that dose will do for him.

There are 2 other important pieces to this puzzle - as folks have suggested already, it helps tremendously when you vary the times of your tests. If I remember correctly, you're running home from work to get that mid-day test - is that right? Just any variety on the times of the testing helps us see better what is going on.

Also, once you've increased a dose, you want to hold it for a minimum of 6 cycles (shots) before considering a dose increase. If you post here before increasing a dose, there are several of us who watch out for people wanting help deciding if it's time to increase the dose. we can teach you what to look for in making that decision so it's done safely.

Does this make sense to you? I know it is counter-intuitive. Do you have any questions? What do you think about doing the reduction?

im worried about going that low to 1.5 as he went in the black when I reduced due to 70bg which I know was probably a bounce but 2.75 is where I got the yellow numbers and lower pink numbers so should I go to that and stay there? also if I go back down to that do I go straight to 2.75 or do it gradually so say 3u at the pm shot.its so tricky to know what to do for the best.it scares how my vet just tells me to jump from 2 units to 3 units rather than doing it gradually.hes going in on Saturday to have his fructosimine checked.kidneys,liver etc will this tell me overall if the units hes been having is enough or not.im learning so much about this every day but still don't feel I know enough to make him better so this is where I need the help of you guys!
I will try to get more tests in.im off work in a couple of weeks as ive asked for an early holiday so I can get this sorted and him tested at all different times.

Hi Anna,

Your vet isn't following the published protocol for Lantus use in cats. He may be looking at the higher preshot numbers and not taking a low nadir into account. My vet was bumping Cobb up 2 units at a time!! The protocol calls for .25, or at most .5 unit increases, unless you are above 10 units.

Cobb has been diagnosed as diabetic since April of last year and has never had a fructosamine test. If you're testing every day and getting enough data, I don't think they are unnecessary. Also, one test isn't really reliable as to figure out dosing. I know getting those extra tests can be difficult, but any extra (other than your preshots and +6) are helpful. Most of us get up at least once a night and have learned how to test in a sleepy state. I get up when I go check on my baby when he cries after waking up. I rock him back to sleep and grab a test on my way back to bed. You'll figure out when you can add other ones in. Unless you work for 12 hours and sleep for 12 hours, you'll find some time that you didn't realize was there. :smile:

When I got to FDMB, Cobb was on 10 units of Lantus, but we got there by increasing 2 units at a time. I was initially nervous by dropping back to 2 units, but we did. We ended up building back up to a high dose, but we did it safely. It's better to be higher for the short term, instead of too low, which can quickly kill a cat.

I know it's confusing when you're hearing different information from what your vet is telling you. They are supposedly the expert, right? Vets have to know about so many conditions that it makes it impossible for them to be an expert in one. The people here really know what they're doing because all they focus on is feline diabetes.

Bailey is our number one concern! We want to keep him safe. :smile:

~Suzanne

What stands out to me, when looking at your spreadsheet, is that we usually hold the initial dose for 5 to 7 days to let the depot of Lantus build up. When you had that 121 PM pre shot test on the second day, I would have tested some during the night, as that was a pretty steep dive from the previous 483 test. Bailey could have gone lower that night, and Bailey also probably bounced from the steep dive and that's why you saw the red numbers.
When you got the 157 mid-cycle test on the 5th day, I would think that your vet would have had you hold that dose as usually vets think that is a very good number. I am wondering if you vet is looking at the pre shot tests only to determine dosing. A lot of vets are used to insulins that dosing is based on the pre shot tests and not the lowest number in the cycle. I think Bailey probably is bouncing from some lower numbers she is getting at night time. Unless you have those night time numbers, we can't see the whole picture.

right then.ive dropped it down to 2.75u at pm shots I didn't want to drop anymore with giving him 3.25 as you've all said not to move too much in units.should i hold it now for 5 days and see where were at and test as many times as I can.it sounds silly but will his ears be ok with all this testing.i do try and alternate between ears each time.
I know all you guys are experienced in all of this and im from that so hope youre not all thinking im a crazy lady messing about with his units .I just want to whats best for my bailey.so his life is yours and my hands now.i really need your help here.im doing my best.
also im struggling with the making a new day topic thing where youlink it to m previous post on here.ive been told how to do it and ive tried but i cant do it.someone on here did it for me the other day.my friends coming tomorrow is less computer illiterate than me ;-) so will show her your instructions on how do it and let her show me.
thanks for all your help xxxx

it sounds silly but will his ears be ok with all this testing.

Click to expand...

Anna --
Take a look at Gabby's SS and Gracie (Marje's kitty) SS. We're both testaholics. Our kitties' ears are just fine. In fact, I test on the same ear. One ear tends to bleed better than the other and that's the ear I use to test.

The bottom line with Lantus dosing is that if you don't let the dose settle and change it too closely to the previous dose adjustment, you'll end up with wonky numbers. Because Lantus is a depot insulin, when you change the dose, you have to give the depot a chance to "catch up" with the change.

I think you misunderstood one thing Anna, but I'm glad to hear you decreased at least some.

Going down in dose isn't usually any problem. It's going up that we go very slowly and in .25 increments. What Julie (and the rest of us) suggested was that you drop back to 1.5u and hold it for at least 3 days (6 cycles) so we could really evaluate how that dose did with Bailey. We would also want you to check for ketones in his urine.

Reducing Bailey back to 1.5 unit at worst would make his numbers stay too high, and high numbers take time to do their damage.(and we wouldn't expect you to keep him at higher numbers any longer than 3 days (6 cycles) before we'd suggest increasing.

Having the dose too high can cause hypoglycemia which can kill quickly.

What we are concerned with is that giving too much insulin can cause not only dangerous lows, but can also set our kitties up for insulin resistance. Insulin is a drug where it's not usually "more is better".

We totally understand that you're scared, confused, and that going against your vet's recommendations can be difficult, but the people here do one thing and one thing only. Deal with feline diabetes at home, 24 hours a day, 7 days a week and would never risk Bailey's safety or well-being. We take it very seriously that we ARE giving advice on someone else's feline family member that they love every bit as much as we love our own.

A little note on your spreadsheet...You have Bailey's PMPS last night as 2 which has to be a mistake. If you don't remember the reading from last night's PMPS, your meter probably stores the numbers for you so you should be able to go back and find it.

yes sorry id missed keyed :-/ changed it now.so if I reduce the next shot to 1.5 and start from there or could I perhaps start at 2 or even 1.75u??? the vet told me to start from 2 as he had previously been on 5 units of cansulin but it wasn't lasting long enough hence us being on lantus! im understanding more and more and have learnt so much more already off this site.youre all marvellous
im checking for ketones every other day with the sticks.(hes been ok so far)
this has definitely by far been the biggest challenge of my life and believe me ive had a lot of challenges along the way!