? 03/02 Chippy, AMPS 205, appetite down, +3.5@98, +7.5@100, 10.5@79, PMPS 80 - NS, +2.5 @ 123

Hi Everyone,
I'm new to this forum (2nd post). Chippy has been doing well on his lantus, and we've been cautiously optimistic about his numbers recently. He has been eating very well - DM with a bit of fancy feast pate or other low carb pate mixed in for variety. This morning he was not as interested in food as he usually is, and only ate about 1/2 his normal amount, or about the equivalent of 1/3 of a can of DM. He seems fine otherwise. He did eat a lot last night. This is the first time since his diagnosis that his appetite has waned at all so I'm feeling a bit paranoid. Is it normal for diabetic cats' appetites to fluctuate? Or is a decreased appetite always a bad sign?

 

Hi Ingrid,

Once they start seeing lower numbers their appetite does normalize. They no longer feel that almost insatiable hunger that they did in higher numbers.
Has he been transitioned to a LC canned diet? The Purina DM canned is low carb but you needn't restrict yourself to it. Any low carb canned food is fine.

Here's the link to your previous post - https://www.felinediabetes.com/FDMB...-new-member-bg-high-even-with-insulin.243036/

Have you decided on which of our dosing protocols you would like to follow?
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Welcome to the Lantus forum

 

Sorry about that previous post - I was having some issues with my phone keyboard.

Thank you for the reassurance about the appetite. I would never have worried about such a thing in the pre-diagnosis days, but am uber paranoid about every little thing now. I have been mixing in other LC foods with his DM, but am focusing primarily on the DM since his numbers did seem to improve once I started him on it. I realize that may have just been coincidental timing but, as I mentioned, I'm a bit paranoid about every change now. I did kind of wave some other food in front of him this morning and he wasn't particularly enticed, so I do think he's just not as hungry as he has been. I'm at home today so may try giving him something different later this morning.

As for the protocol, I'm not sure we're following any protocol yet. Our vet advised to keep him on the current dose until at least this coming Friday, at which point we'll reevaluate. Given that we're starting with 2 units/twice daily is the SLGS protocol even an option?

Thanks again!

 

Hello, I'm posting again with an additional question/request for advice. I just spoke with my vet, and after reviewing Chippy's numbers she wants us to decrease his dose from 2 units/2 times a day to 1 unit/2 times a day. I'm definitely on board with reducing the dosage since his numbers are getting low, but from what I've seen on this forum, reducing it that much seems drastic. I think eventually we'd like to try the tight regulation protocol, but we're new enough to this and nervous enough that I'm not yet comfortable pushing back on my vet's advice. Just wondering if it's way outside the norm to reduce the dosage by that much at one time. I trust my vet as she has years' of experience as a feline practitioner, but am still super nervous.

Sorry if I'm posting this in the wrong place. The posting guidelines indicated one post per cat per day, so I hope it's ok to tack on to my earlier post.

Thanks!

 

Hi Ingrid and welcome! You're doing everything right, just remember to post your previous conversation to the present day's thread so we can review it before tackling the new day's questions and issues.

If you are following Start Low Go Slow (SLGS), then you'd reduce the dose anytime your cat goes below 90, which Chippy did last night. On FDMB, we increase and decrease in increments of .25 units. This reduces the probability of missing a dose that might be beneficial to the cat to keep him in normal numbers. If you take your vet's advice and reduce by a whole unit, you might see some high numbers which would mean you'd have to go back up again eventually. I'm going to tag some more experienced members here (@tiffmaxee , @Wendy&Neko , @Marje and Gracie , @Gill & George ) to see what they would advise but it might be prudent to consider going down to 1.75 rather than 1. If you decide to follow TR, you would hold the 2 unit dose until Chippy fell below 68 (since you are using an Alphatrack, 50 if using a human meter). Since Chippy is only being fed wet food and it seems like you test enough, you might want to consider doing TR as it might help him towards remission a little bit more quickly but you'd have to be able to handle more low numbers, with which of course we are here to help you.

Do you have syringes with half-unit markings to do a .25 unit decreases/increases if need be?

 

Hi Ingrid. Welcome to you and Chippy. For now until you de ideif you wish to follow one of our methods I suggest you reduce to 1.75 which would go along with our more conservative SLGS method. Chippy hasn’t gotten into really low numbers so far so a .25 reduction after falling under 90 makes sense. If you decide later to switch to TR you would reduce if he falls under 68 so you can see his current t numbers are quite safe and you are testing enough to catch any low numbers. You are getting a really good response to Lantus and cutting the dose in half might very well stop this progress.

 

Katherine @PerfumedCatMom asked some excellent questions. If you want to keep posting here, we can help you figuring out how to do the dose changes on your own. I found after a while it was too hard to get in touch with my vet when I needed answers and just stuck with here. We use the two dosing methods here that have been mentioned, and as long as you are feeding only low carb wet or raw food, the choice is yours. Pick what suits your goals for Chippy and your lifestyle. And you can switch from one to the other if at some point your circumstances/comfort level changes. Tight regulation is a more aggressive dosing method, and does require testing the preshots plus at least one other test each cycle in the AM and PM both.

As you are fairly new to testing/feline diabetes, you might want to go down to 1.75 units per shot.

 

Wendy and I cross posted. I’m glad we agreed! Seriously I hope you do go down to 1.75.

 

Thank you, Katherine! Yes, we do have the syringes with the 1/2 unit markers, so could go down in smaller increments. Yes, our vet warned us that the numbers might increase back to the purples and reds and said we'd revisit on Friday. I feel as though she's not a proponent of the TR - she's warned me several times about a client (an MD) who adjusted the doses on her own and wound up in the emergency room with a hypoglycemic cat. I'm hesitant to go against her recommendations this early in the game, but I also don't want to do any damage to Chip when he seems to be doing better. I wonder if anyone has advise on how to advocate for the TR with a reluctant vet?

 

Is the vet seeing your spreadsheet regularly? I handed my vet a copy of the dosing methodology I told her I was going to use and she got regular updates on the spreadsheet, until it stopped being an issue.

 

I did the same with my vet on the spreadsheets. He’s an internist and started showing my spreadsheet to his third year veterinary students. He stopped giving dosing advice on his own. He just asked me to send him the ss every few weeks and reminded me if I forgot.

 

Yes, she is seeing my spreadsheet. She's a good vet, but has very strong opinions. As you mentioned with your vet, my other issue is that she can be hard to get a hold of. She's a sole practitioner and doesn't have an office (she is a mobile vet) so on her off days she's truly off. I'm glad to hear from you and Elise that his numbers don't seem too low. DH and I were both very nervous about his numbers last night, and I only half slept all night because I kept getting up to check on Chip (which is probably why he was a bit off this morning - we were both exhausted!)

 

I just tested him again and am now even more confused about what to do. His BG is down to 79 1-1/2 hours before his next shot. I still don't quite understand where his nadir falls. He was down quite a bit at 3.5, up a bit at 7.5, and now down again. I'll test again before his next shot, but if the number is still this low, does 1.75 still make sense? Given how much it dropped last night after his PM shot, I'm just terrified he'll go too low overnight.

 

Hi Ingrid, I'm bumping your post because I think more eyes need to be on your situation. How far are you from PM preshot?

 

Can you get a +11 test?

 

He is still in safe numbers. A lot can change in a couple hours. Maybe post at +11.5 and ask for help if his numbers are still low enough to be concerning.

 

Thank you, all! We just took his PMPS and it was only at 80. DH and I both read through the SLGS protocol and are more comfortable following that routine until we have a better understanding of where his nadir really is. Accordingly, we decided to skip his shot tonight. Is that an appropriate decision under the SLGS protocol?

 

Posting to bump! And welcome

 

Yes, if his preshot is below 150, you can skip under the SLGS protocol. Nadirs will move around, especially before the cat is regulated.

 

With SLGS, you always skip if under 90. When you are new, you skip on higher numbers, like 150, until you have more data and experience shooting gradually lower numbers.

You can go ahead and feed if you haven't already. You might want to test in an hour or so to make sure he's stopped dropping.

 

I just tested him one last time. 2.5 hours after he ate dinner he's at 123, which seems good to me. I'm a bit nervous to see where he'll be in the morning, but at least we'll both sleep a bit better tonight. Thank you all for all your help!

 

If you follow our SLGS method a reduction has been earned and the new dose would be 1.75 going forward.

 

As @tifmaxee said, yes he needs a reduction to 1.75u as he dropped below 90.

I would add that as you have skipped he might be high in the morning as he would have had 24 hours without a shot and Lantus doesn't usually have that long a duration.
If he is high don't try to 'shoot down that number' Lantus dosing is usually based on the nadirs not the PreShot values. Stick with the 1.75u dose.
If he were to still be low (blue) in the morning, stall without feeding and post for help. I should be around for your amps. So I will watch out for your post in case you need some help.

that's good that she has access, the other thing @Wendy&Neko does she have a copy of the dosing methodology that you would like to follow? Perhaps if she sees that you will be following a sensible approach, not adjusting willy nilly, approaches that many hundreds of cats have safely followed and that you are also monitoring she may be OK with you adjusting the dose. Interestingly since I first came on this site, I haven't seen a cat end up in ER with a symptomatic hypo, as long as they have been following the guidelines of either TR or SLGS. I have however, seen cats end up with a symptomatic hypo, because of inappropriate starting doses, or doses taken up in much too large steps, with little or no home monitoring, all under guidance of a vet with not much experience of dosing with Lantus.

As for his appetite, I also noticed that once George was regularly getting into better numbers (under 200) his appetite normalised, he went from ravenous (eating my toast with blueberry jam) to just regular hungry George, and if he dropped lower than he was used to or fast, he would get really insistent that I feed him.

Thankfully you are monitoring at home, and doing a great job of that, so you are doing everything you can to keep your Chippy safe, and we are here to help, we have members all across the globe, so there is usually someone about to help 24/7.