2/7 Chyna AMPS 419; PMPS 362, +3 288, newbie

Hi,

I've posted a few times on the main board and it was suggested that I come here for more specific help with Lantus. I'm not sure how to do the tight regulation so maybe I should be on the relaxed Lantus board? My spreadsheets and profile are up to date. I started Lantus Jan.11 (was on Caninsulin before, from Dec 1 when we first started insulin) and like it much better. I'm slowly trying to switch to all wet food, against my vet who thinks I should still give some dry. I'm waiting on an automatic feeder in the mail so I can give her a little meal or two timed between injection meals as she will just eat wet all at once if I leave it out for the day on my way to work, where with the dry she nibbles. Even the wet as ice cubes, she likes to lick them, lol.

I've been trying to reduce her food a bit slowly, to help glucose levels now that she is mostly out of the high 20s/low 30s for mmol/L. At first the vet had me just leave a bowl of dry out and give 1/4 can wet at injections, so I've started measuring the dry. Some people say to give as much food as they want as she is unregulated but I'm worried that will keep her high? On Tuesday, I reduced her calories to be her "ideal", hopefully, I'm not sure what her ideal weight is. I guessed at 10 or 11 lbs, she is 10.6 lbs right now. So I ended up reducing her dry food by 1/2 tablespoon every 12 hours. Then Wednesday (yesterday) my Chyna cat surprized me by having our first single digit glucose reading mid day (I checked at lunch break) and kept going lower. PM pre shot was 6.3, which is when I posted for help! I ended up skipping last nights injection and feeding like normal. My question is, do I reduce the dose based on yesterdays numbers? I gave her the normal 2.5 units this morning, as her AM pre shot was back up to 23.3. Also, if I am switching to all wet food "cold turkey", should I reduce the dose a bit the day I do, before I see the glucose numbers shoot down too low, assuming they will? Sorry I posted in mmol/L I'm not sure how to convert. Thanks for any help, this site is awesome and even though I didn't post at first, it helped to read stories of others having ear testing trouble and injection problems, I didn't feel so alone

Re: New here, food and reducing dosage question

Welcome to LantusLand, the best place you never wanted to be. We are glad to help with your sweet Chyna. What a pretty kitty! I (and just about everyone else) will strongly recommend that you banish dry food from your house. The carbs are way too high for cats and, besides, it's dry, which is bad for healthy cats and terrible for diabetics who are perpetually dehydrated. Lucky you that Chyna will switch to wet food so easily! It took us MONTHS to get Zener on to wet food. You are right to be cautious about the blood glucose level when you switch to low carb wet food. The conversion from mmol/L to mg/dL is a factor of 18. So when you got a 6.3 mmol/L, that is 6.3 * 18 = 113 mg/dL. Can you get a baby scale to weigh Chyna? That's the best way to tell if she's getting the right amount of calories.

Don't be shy about asking questions. We are glad to help in any way that we can.
Liz, Zener's other mom

Re: New here, food and reducing dosage question

Hi and welcome to LL!!

I agree that Chyna is very lovely!!! I have a soft spot for tortis and calicos!

Regarding the advice that you can let her eat as much as she wants because she is unregulated, that's not really good advice. You might find this post on Feed Kitty as Much as They Want informative.

You are more than welcome to post here if you don't wish to do Tight Regulation but you are testing plenty during the day to do TR. We do ask that you try to get at least a +2 or before bed test (whichever is later) at night. Cats often dip lower at night and without some tests, you are missing half your data. The TR protocol is the only scientific research-based protocol published in a veterinary journal. Removal of dry food is a requisite to using the TR protocol. If her numbers drop low, you need to be able to use canned food to bring the numbers up quickly. Dry food takes a long time to kick in and raise the BG and then it keeps it elevated a long time.

If Chyna's ideal weight is 10 lbs, then, according to the TR protocol, a starting dose for her would be .25u/kg. So her starting dose under the TR protocol would have been 1u.....if she had been eating canned food and you were using the TR protocol.

I would not reduce the dose based on yesterday's numbers. IF you continue to feed dry food. She was in lovely, normal numbers. The TR protocol calls for a dose reduction for newly dx cats when the BG drops below 50; the Start Low Go Slow Approach calls for a reduction if, after 1-2 weeks on a dose, the BG falls below 90.

If you go cold turkey to canned food, you will need to reduce the dose. Many of us often read and take very much to heart information from Dr. Lisa's Website. From her page on diabetes:

If you change your diabetic cat's diet to one with lower carbohydrates, he will, in all probability, IMMEDIATELY (not days or weeks later) require a reduction in his insulin dosage. He may also immediately go into 'remission' and not need any insulin at all.

If this warning is ignored, you may very well end up with a cat in a hypoglycemic crisis (dangerously low blood sugar) which can result in death, or brain damage.

If you take only one point away from this page, it needs to be the understanding that if you stop pouring carbs into your cat by switching to a low-carb canned food diet (or even a dry food diet with lower carbs than you have been feeding), you MUST be aware of the probable immediate and significant impact on your cat's insulin needs.

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If you wish to follow the TR protocol and plan to do cold turkey, please post here and then we can decide on a good dose for her.

Re: New here, food and reducing dosage question

Thanks, I think she is a beautiful kitty as well, but I may be biased I'm lucky to have such an easy going sweet cat, now that she is used to the routine she is very good. Nothing like a few videos of ear testing I watched online of hissing spitting kittys. She was just confused and a little impatient.

I think as soon as the automatic feeder shows in the mail, I will be trying the switch to all wet cat food, cold turkey. I'd only be able to start that on a weekend when I'm home for 2 days or I'd worry myself to death at work so I really hope it comes in today or tomorrow. So if I do the go slow one is it a different starting dose than TR? I just want her better. I do have a postal scale that should work for weighing her once I get a platform to sit her on, last time I just used my digital bathroom scale and weighed myself, then her and myself to see the difference.

I have been trying to get home during this week at lunchtime to do testing with the reduction in food, but I can't make it home every day so I wouldn't be able to get those numbers daily. Evenings it shouldn't be a problem to get one at +3 or +4. I did hear that night time was lower than day. I do have a few cans of fancy feast tuna feast in gravy and some maple syrup, as well as some syringes ready in the cuboard in case I need them, and of course the dry food. I'm at work now so can't read all the articles but wanted to answer you both. I guess I'll find out tonight when I do my pre shot test if her numbers kept going down like yesterday 12 and 14 hours after AM injection...is it normal to skip the injections when this happens? I don't want to mess up her system. There were so many different things suggested in articles I got confused, like delaying it...and I had to go to bed :?

Re: New here, food and reducing dosage question

It's a LOT to learn. I would suggest that you get a pre-shot reading tonight, maybe 30 mins before you want to shoot (if that works with your schedule) and post here with the number if you're at all concerned about a low number or something else. If you could change your subject line of the very first post (so it will show up in the forum) to
2/7 Chyna AMPS 419 newbie

Then when you get the evening pre-shot test (PMPS), change the subject line to
2/7 Chyna Cat AMPS 419; PMPS ___ newbie

This is our method for everyone to see very quickly what's going on with each cat, just by reading the subject line of the main forum. Some of us, but especially the dosing experts (like Marje, Sienne, and others) follow many cats each day so we want to make it easy for them. If you have a question, then use the ? icon and put ?? in the subject line. That will get more attention.

When someone posts a response, then Chyna's condo gets bumped to the top of the list. So if you need some help, post a response (rather than editing an existing response).

You and Chyna are doing a great job! This is tough stuff but we are all crazy cat ladies so will do just about everything we can for our kitters.
Liz

Re: New here, food and reducing dosage question

LOL! Sorry I had to laugh at the maple syrup. Only a fellow Canadian would be giving maple syrup.. the americans are all into the corn syrup but maple is better , especially on pancakes.

Marje - she dropped to 88 last night after 21 cycles and a skipped shot. I am not quite clear why this SLGS wouldnt require a decrease here based on what you said?

the Start Low Go Slow Approach calls for a reduction if, after 1-2 weeks on a dose, the BG falls below 90.

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please can you clarify?

2/7 Chyna AMPS 419 newbie

Hi again, I'm just changing the subject line as recommended, thank you for telling me how to do this hopefully this is what you meant for me to do I will post a pre shot PM later. And yes Wendy, maple syrup is good on pancakes, lol. I couldn't even find corn syrup in the grocery stores I looked in

Re: 2/7 Chyna AMPS 419 newbie

Sorry to just get back to you....I had to go out for a bit and needed some time to look at her SS after you posted.

To answer Wendy's question, the SLGS approach states:

Step 3. After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve (blood glucose tests every 2 hours, starting at shot time and continuing until the next shot). Follow the cat’s normal feeding schedule during the curve. The curve should be evaluated by someone experienced at interpreting feline blood glucose curves, in order to check for signs of rebound and other possible problems. If no rebound is present, follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):
a) If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
b) If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
c) If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.

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I was providing that information just so she had a reference for what constitutes a number for a reduction under the TR protocol vs the SLGS Approach. But she hasn't been following either protocol. The starting dose for the TR protocol would have been 1u and for SLGS Approach is between 0.5-1u.

After looking at Chyna's SS closely including the remarks, I realized that you are feeding DM dry and only a small amount of it so it is probably not contributing to the numbers much. Here's what I would suggest:

• leave everything as it is right now.....the dose, the dry food, etc and collect data from now until the weekend,

• be sure you don't miss any preshot tests and try to get as many midcycle tests in the next couple days as you can during the am and pm; understand you work but do the best you can. A +3/+4 at night is great and if you are up early, perhaps a +11 in the PM cycle (that would be an hour before AMPS). On 2/3 a.m. cycle, I'm not sure why you didn't shoot but she was coming down and you got no more tests even at the PMPS. That's the kind of data that tells us so much and helps us help you and Chyna.

• if a test subsequent to the PS indicates she is dropping, see if you can get another test a few hours after (unless she is low and then you want to post for help on when to test again). It would have been great data for us last night if you had been able to test to see when she started back up. Again, I realize you work but that +3/+4 would have shown us if she was already headed up.

• keep posting so we can help you analyze the data and then suggest what the next step should be on dose (it is possible she is coming down at night and bouncing back up during the day but it's just hard to tell without those additional tests),

• look at the TR protocol and the SLGS Approach and decide which one best fits for you; look at other members' SS and you can see there are many following the TR protocol that work; I'm not trying to pressure you but the TR protocol gives the best chance for a newly dx cat to go into remission and oftentimes a switch from dry to wet can really move kitty along towards going into remission,

• if you are not able to get a few more tests, cannot post here, or do not want to follow TR, you should reduce the dose by at least .25u each cycle and you should even consider dropping the dose back to 1u bid,

• start testing for ketones daily and if you reduce the dose by any amount, you might even want to test more often than that; you can buy ketostix at the pharmacy; if you have questions about how to test for ketones, let us know and we'll help

We're glad you all are here and are anxious to help you and Chyna so I hope you'll stay, keep posting, consider the above, ask questions.

Re: 2/7 Chyna AMPS 419; PMPS 362 newbie

Rachel, you can follow either protocol and post here. If you choose the SLGS protocol, you can put that in your signature so everyone knows that's what you're doing. There is a lot of activity on this board so you will get faster responses to your questions, especially when you get a low number at preshot.
Liz

Re: 2/7 Chyna AMPS 419; PMPS 362 newbie

Ack, sorry on the 2/3 am cycle I did give 2.5 units, just missed putting it in the spreadsheet, sorry. The first shot I've ever skipped was last night! The only thing I've been following is what my vet told me to do; when we started Lantus she wanted mini curves for the first two days and then a mini curve every Saturday at AMPS, +2, +5, and +8 for four weeks. The rest of the testing was me being curious and I'm glad I was. I put SLGS in my signature for now, even though I'm so confused I'm not sure what I'm following anymore! I think the starting dose I was told was supposed to be 2.25 units that she based on having been on previous insulin, body weight and her high glucose but the vet wanted to start off lower at 1.5 units? I believe she was going by this:

http://www.uq.edu.au/ccah/docs/diabetesinfo/link3.pdf

I do want to switch to all wet food, and then I will need some help in dosage for sure I will try to read through both protocols, but my eyes are so bleary right now from lack of sleep last night worrying that I am ready to drop, so if I'd thought of it I could have gotten some of those tests, that was dumb of me since I was awake anyways. I'll get more evening numbers too and leave the food/dose etc the same for the next day. I have ketone strips and have tested once, last week. She is drinking/peeing less now with the lower numbers so harder to catch her but I tried the aluminum foil folded up at the edges a bit in one of her "spots" in the litter box and it worked that time so will have to try again. Thanks again.

Re: 2/7 Chyna AMPS 419; PMPS 362 newbie

The protocol that the vet gave you is the Tight Regulation Protocol that many of us here follow. The differences between the two protocols involve when a dose reduction is given and how long a dose is held. The major difference between TR and SLGS is that TR has research behind it. TR also has an admirable record for helping to get newly diagnosed cats into remission.

Take your time and read over the approaches over. You may want to read through the starred, sticky notes at the top of the Board, as well. Please let us know if you have questions or how we can help.

Re: 2/7 Chyna AMPS 419; PMPS 362 newbie

Rachael

The link you provided is to the tight regulation protocol :lol: that's great that your vet provided it to you. The only problem I see is that it's "possible" (again no proof) that her numbers in caninsulin were high because the dose was too much. The increases of .5u which were given also are in accordance with the TR protocol except without those night tests, we wouldn't have recommended an increase.

You don't need to worry about reading everything before the weekend. Just collecting the data and asking questions will be great. We're here to help you so just let us know what you need....and we will keep an eye on the n very, too.

Thanks, did a PMPS +3 now it's time for bed

Good job. If you can, could you please get a +11? Thanks and hopefully we can start figuring it out.