1/3/21 Chicamonkey AMPS 369/+4 375/+6 390+9 339/PMPS 389/+4 399

Monkey was in the bounce house all evening and it looks like the same today....

My question is, how much insulin is too much insulin?
How many kitties are at 3 units or higher ?

 

Suzi today is 1-3-21 fix your title

 

Hi Suzi

I know you are worrying about the insulin doses being upped every 3 days. I am sure you are also wondering why you saw good numbers at 1.25U and if you're giving her too much insulin now.

A cat can be on too much insulin if you have started out at too high a dose, or the dose is increased by large amounts bypassing a good dose and if you are not testing enough to see how low the cat is going on the dose. None of these conditions apply to you/Chica. Also, 3 units is not considered a high dose. We ask to test for secondary conditions that cause insulin resistance like acromegaly or IAA (insulin auto antibodies) only when the dose crosses 6 units.

There are several kitties here who are/were on 3 units or more. Here are a few examples:
Butters
Henry
Tibby
Cosmo
Squeaky

I've just named a few who post regularly and so their names are at the top of my head.

Bandit looked like she was headed for a reduction at 1.25U and then for some reason she needed more insulin and I had to take her up to 2U. And I was as worried as you since it was the highest she had been since we started her on Levemir. But 2U turned out to be a good dose and she started coming back down the dosing ladder. The same is happening with Henry and Butters.

You just have to keep increasing - in increments of 0.25U and testing - till you hit the right dose. At some point Chica will break through whatever is causing the high numbers. Do not worry about an absolute number in terms of a dose. She needs what she needs and the sooner you get her to that number, the lesser the chance that glucose toxicity develops.

If Chica is getting too much insulin, she will tell you by going low.

Just keep at it and I am sure you will get there!

 

How do you know this??

A cat can be on too much insulin if you have started out at too high a dose, or the dose is increased by large amounts bypassing a good dose and if you are not testing enough to see how low the cat is going on the dose.

 

I’m so curious where this data is from

 

Suzi

We know this from decades of data and experience within this site and studying SSs. We know this from the research done by Roomp and Rand who published the TR protocol. We know this from direct contact and emails with Kirsten Roomp who formed the sister German FD forum and was the first to develop the TR protocol.

When the site was started long ago, there was a vet tech, JoJo, who was extremely experienced with FD and she posted here to help out. She mentored many people including Jill (Jill and Alex), who we suddenly and sadly lost 1.5 yrs ago. Jill mentored many of us here including Wendy, Sienne, and me. Another long-time member, Libby, who no longer posts, was extremely experienced and gifted at reading SSs and spotting patterns. She also mentored many of us.

It’s reasonable to ask questions; Sienne will tell you that I asked more questions than probably any newbie because I’m a biologist and that’s inherent in me. But what I never did was doubt the experience and knowledge of the people here because I could tell they understood FD more than my vet. I could see the results that members got by following their advice. I could see the number of cats going into remission as well as the number of cats who might never go into remission but were tightly regulated. I could see the number of acro cats who were actually pretty well regulated and it takes experience and knowledge to get those kitties to that point.

Chica has not yet hit the dose that puts her in normal nadirs. A cat needs the amount of insulin its own body needs; for Chica, maybe that will be 3u bid. Maybe it will be more. One basic premise here is “don’t get attached to a dose”. You’ve raised the dose slowly and systematically to this point so we know she is not overdosed. We’ve seen what happens when members think their cat is overdosed and they do a rebound check by reducing the dose which then needlessly puts the cats in high numbers for a longer time. The other thing with overdosed kitties is that they tend to eventually drop like a rock into low numbers.

Remember that kitties are not tiny humans in fur coats so they will not react to insulin as a human might. Their metabolism is very different from human, and even dog metabolism. There are also many things that can affect the BG including ones you wouldn’t even imagine like barometric pressure! I often remarked on how my Gracie seemed to be a “seasonal” diabetic in that her BG improved spring through fall and looked horrible in the winter.

You can either have the faith and trust that we have a better understanding of FD here than anywhere else or you can choose not to. I hope you will trust us. I hope you’ll look at other SSs and see how it takes time and patience but many cats get well and tightly regulated. I know you’ve heard that FD is a marathon and not a sprint.

 

Spot on Marje

 

O please don’t think I’m challenging anyone... I just want to see the data with my eyes.
Also so if someone did start giving 2 units like the vets recommend so often.... then they started tr would that make cats insulin resistant ?

 

And I don’t have children... Chicamonkey is my baby. I trust in FDMB A LOT.... or I wouldn’t be here. But the Registered Nurse in me, likes to see data.... that’s all

 

She trusts me... and I trust you

 

I’m happy to answer this question except I’m not really sure what you are asking. What causes insulin resistance is the BG being high for an extended period of time.

I don’t think any of us see it as challenging us We understand and we all asked questions; that is to be expected and we welcome that. Let me see if I can find some good SSs to show you. Unfortunately, google made some changes a few years ago and some SSs are no longer accessible but let me find one.

I do want to be sure you see Henry’s SS that Bhooma linked above. Look at the 2020 tab. Henry was FD for some time and not making any progress when Robert found our site. Unfortunately, the dose was dropped back way too far and glucose toxicity set in. I worked with Robert to fast track the dose back up; he agreed to get rid of the little bit of LC dry food and to then TR. You can see what resulted

 

So, that is a major part of my concern. If you look at monkeys ss, it seems like the higher we go the worse her bg climbs and the more she bounces.
Like right now we are in cycle 5 at 2.75 she’s at 390 at +6, so when we say she’s bouncing from yesterday’s 184... look how high she’s been and for how long ....
and I would understand “a” bounce but she’s bouncing and not coming down

 

A bounce can take 4-6 cycles to clear.

 

Here are two extreme SSs of cats started on too high of a dose. The first one, Tucker, was started on 6u of Vetsulin bid. It didn’t take long to see he was overdosed. Insulin was stopped while we waited for the bounce to clear and then he was restarted on 1u of Lantus. He had a quick response to that and he actually went into remission really fast.
Tucker’s SS

Teronto was started on 10u Lantus once a day (crazy). He was in really high numbers even after insulin was stopped. His SS shows you what the depot can do and how long it can last especially in an overdosed cat. It’s likely he went low somewhere while he was on 10u but the CG wasn’t testing based on advice from the vet. Teronto did what we call “bouncing to remission” because he did so up until the time he went off insulin and that was because he actually didn’t need it. The insulin he was getting + his endogenous insulin was causing this scenario.
Teronto’s SS

Usually we don’t see such extreme examples and I’ve been trying to think of a different one where the cat wasn’t started quite so high but too high or the dose was started at 1u bid and then increased each week by 1u and the cat became overdosed. If I can find one, I’ll post that. This last scenario is not uncommon.

In some cats, we see an initial drop in the BG following a dose increase. You can see this on Monkey’s SS in a couple places.
12/10 increase to 1.25u
12/25 increase to 2.25u
1/2 second cycle after increase to 2.75u

Sometimes those numbers are due to bounce clearing. If you look at any cycle where she drops a lot between PS and +2, like in the a.m. cycle of 12/29, she likely kept heading downwards. That large drop can cause a bounce and bounces have to clear. When they clear, they build up more momentum and so the BG drops more and often, lower. That can initiate a new bounce; it’s a cycle we see often and my own kitty would do it from time to time. We have methods of feeding the curve to manage it so the dive is slowed down so the bounce is not so hard.

As Gill was saying yesterday, instead of just feeding her twice a day, take the allotted number of calories for the day, divide it into two. She will get fed half of that in the a.m. cycle and half in the p.m. If possible between your DH and you and an auto feeder, start by dividing the cycle portion into four mini meals and feed her at PS, +1, +2, +3. See how the BG responds. It takes time and experimentation for each cat. It’s possible that she will need a different type of feeding schedule to work better with her insulin.

Monkey is not coming down into normal numbers because the dose isn’t the right dose. When a kitty clears a bounce and doesn’t drop into green, the kitty is likely going to need more insulin. I know you are probably tired of us saying this and I know your schedule is what it is but any cycle where you don’t get at least one other test is a cycle that anything can be going on. Without data, I won’t make any suggestions on dose increases. I know it’s tough when you see a high PS to just not want to test the rest of the cycle but it is important to get at least one more test especially in the evening.

However, we don’t jump into that when a cat is seeing some blue BGs because some cats, like my kitty was, are slow responders. Since the effects from each injection are cumulative as the depot builds, if we are seeing any response, we hold the dose just a bit longer to see if that dose is enough to get her into numbers below 100.

Does that help? Questions?? I’m happy to answer any other ones you have or clarify anything that doesn’t make sense. Sometimes I start writing and it makes sense in my head but maybe not when the reader reads it

Please be sure to link the previous condo so we would appreciate it if you would add the link to yesterday’s condo in your first post today.

 

It does help... I’m just a worried mom I guess.

my next question....
I live in Florida, Florida has bugs.
A. Can an auto feeder store wet food?
B. If so , is it well sealed???

 

People do use auto feeders with wet food. They even have room for ice packs.

 

We all are here, so you've come to the right place

@Sue and Luci , could you please help with this? Thank you!!!

 

Oh gosh....I worried the entire time Gracie was diabetic! We all understand that!!!

A. Absolutely! I have the PetSafe 5 as do many other members and I use these dishes inside as I don’t like my cats eating off plastic.

B. I feel it is well sealed but I live in AZ. We never had any issues with ants but then we actually don’t have any bugs in our house except the occasional spider and scorpion. I’ve not heard of any members complain about bugs getting in them and we have had a lot of members from FL and other humid climates.

 

Hi Suzi, As we've already mentioned I live in Naples and I use this automatic pet feeder with wet food only.

https://www.amazon.com/PetSafe-5-Me...r&qid=1609701855&sprefix=auto,aps,204&sr=8-12

I pick up the feeder, remove the tray and wash it every morning as well as her food dish. Only once in a great while have I found those tiny little pesky ants in her food dish, but they apparently didn't figure out the auto-feeder and hadn't invaded that yet.

I leave food in it every night - and of course she gets fed frequently during the day - so there's always a bit of food leavings in that food dish so it has to be washed a couple of times a day...and I feed her after every test - because it helps regulate her blood glucose - keeps her from falling too fast when she starts to drop. Things aren't exactly the same right now for Luci as Chicamonkey because of Luci's hyper-t issues...but hopefully soon she'll get back to her better days.

 

How much do you feed her after every test

 

Lol! I remembered you were from Naples but not that you had an auto feeder.

 

Suzi: What Sue does with Luci in terms of feeding is really specific to what works for Luci. It will not necessarily work for Monkey and I actually know of few members who feed after every test. Most cats don’t need that but I know Sue has learned enough about Luci to know it works for her.

As I said in post 15 above, feed Monkey her normal allotment divided into minimeals. Start with even amounts in each minimeal and start with PS, +1, +2, +3. Give it time and see how she does. When I did this with my Gracie when she was on Lantus, I found out that she did better if I fed her at PS, +2, +3, +4. We can give you a starting place but you have to do the work to determine what works best for Monkey.

 

I fed Max at PS +2 +3 and +4 right from the beginning because he had chronic pancreatitis and needed small meals more often. It also helped to feed mini meals to keep him hungry in case I needed to feed him to keep him above 50

 

During the week I can only get a +2 before I leave for work .

 

Look at my sweet girl

 

And I totally understand that and I know each cat is different... so far, it will bec6 weeks on lantus this week.
She gets ff pate classics only 2-2.5 cans a day. I can divvy that out for her.
I’ll find monkeys groove..... I will.

I used to know an endocrinologist that would shoe up at 5 am to do his own blood sugars on his diabetic patients ... I knew he was working for them... just as I care for monkey through you all.
I will have more questions...
I will.. that’s just me.
I want to get as good as you (all)
So I can help others too but, this beginning phase.... the bot knowing and inexperience..... is really hard on a seasoned nurse......

 

It takes time...don't be hard on yourself! I was in wide-eyed wonderment at this place for the first year - really...it took a lot of reading and studying other people's comments, condos and spreadsheets to get some insight into what was going on around here. Yes, Luci has been a challenge and one thing she seems to be challenged by is keeping her weight up - at first it was the diabetes itself that was causing her to lose weight and then it was a struggle to get her to regain the weight she'd lost...and now it's the hyperthyroidism that's caused her to once again become under-weight...she seems to lose weight so easily so yes, I'm more generous with her feedings than most might consider the norm.

So, every cat is different. I had to learn about 'feeding the curve' - in order the keep Luci from plunging I had to test more often and feed her when I'd catch her falling too fast...it's a learning experience...many cats respond very easily to various carb amounts in foods...so that's something you need to experiment with...when the numbers start to slip too fast, get out the lowest carb you have, try a teaspoon...if she's still sliding you might want to find a low-carb that's perhaps around 5% carbs - how does she respond to that one? So on and so forth ... keep records of the carb and amount of food you're feeding in order to keep her from going under the line (for SLGS it's 90, for TR it's 50)...then later as you start to get more comfortable, how many times has she gone under 50 and did she hold the reductions well? Or in Luci's case, doesn't hold a reduction well at all...so I'd have to increase...watch the numbers go down...and if she got away from me (went too low), I'd decrease again...so we've done a lot of ups/downs...it happens.

You'll start to see patterns...but it's a good bit of effort on your part to try to catch all these numbers - especially at night - when kitties seem to like to do their best work.

So hang in there...read as much as you can - visit other condos to see what others are dealing with - look at their spreadsheets to see where they are in their journey - I'll never forget @Sarah and Blaze - he was a real pistol for going low at night - Sarah had two jobs! So it was a real test to get him into remission but they did it! Look up her condo and see where they started...there are lots of examples here for people who work - and yet still manage to get enough tests to cover their kitties and many make it into really great numbers.

You'll get there! I can tell you've got the heart for it!

 

Questions are great and we usually have answers. While it’s up to you to figure out what works for Monkey, we can give you suggestions of things to try.

Just another interesting example of ECID is Sue being able to use 5% carbs when Luci is sliding. That was what I used regularly with Gracie and I had to go to 10% on the drops.

 

Thank you!

 

Lots of good info in this condo today. Good for you on asking the questions Suzi. We've had numerous people from the medical field here, as well as some vets who learned a thing or two. And taught us in return.

You asked how many kitties were at 3 units or higher. To answer, Neko topped out at 8.75 units. But over her 5 years (almost) on insulin, her "good" dose varied from 8.75 units, over a couple years down to 0.75 units, creeped back up to around 3, then zoomed up to 7, then turned around went back down to around 0.25 units when she passed. I learned not to focus on the size of the dose. it really didn't matter, the important numbers were the blood sugar numbers. The insulin dose was just the way to get her to BG's I wanted to see. Of course, she was a little more complicated. Neko had two secondary endocrine conditions that sometimes cause cats to need higher doses. And later on she had kidney and heart disease, both of which can contribute to insulin resistance, though they didn't really much in her case. For a read on insulin resistance, see this presentation. Anyway, I learned that to just follow the protocol, it got me where I wanted to go.

I can share another spreadsheet of Simba - hardly any testing at night and the caregiver went up 0.5 units at a time. He went up with too large an increase and not enough testing to know the nadirs. I always worry when I see black numbers and little or no testing. My immediate question is "what caused that high number?". The caregiver was not a frequent poster. On 3/25, Simba finally gave a clue what was happening in the middle of the cycles where there were not tests, with a PS of 26. When the CG posted again, I suggested he lower the dose. It still seemed too high, and the next 0.25 unit reduction down the blacks went away. The cat did go OTJ not long after.

 

[
Lots of good info here!
I’m going to print
Today’s thread so I can deter back!
Thank you all.... get ready for my next questions... haha

QUOTE="Wendy&Neko, post: 2712001, member: 5773"]Lots of good info in this condo today. Good for you on asking the questions Suzi. We've had numerous people from the medical field here, as well as some vets who learned a thing or two. And taught us in return.

You asked how many kitties were at 3 units or higher. To answer, Neko topped out at 8.75 units. But over her 5 years (almost) on insulin, her "good" dose varied from 8.75 units, over a couple years down to 0.75 units, creeped back up to around 3, then zoomed up to 7, then turned around went back down to around 0.25 units when she passed. I learned not to focus on the size of the dose. it really didn't matter, the important numbers were the blood sugar numbers. The insulin dose was just the way to get her to BG's I wanted to see. Of course, she was a little more complicated. Neko had two secondary endocrine conditions that sometimes cause cats to need higher doses. And later on she had kidney and heart disease, both of which can contribute to insulin resistance, though they didn't really much in her case. For a read on insulin resistance, see this presentation. Anyway, I learned that to just follow the protocol, it got me where I wanted to go.

I can share another spreadsheet of Simba - hardly any testing at night and the caregiver went up 0.5 units at a time. He went up with too large an increase and not enough testing to know the nadirs. I always worry when I see black numbers and little or no testing. My immediate question is "what caused that high number?". The caregiver was not a frequent poster. On 3/25, Simba finally gave a clue what was happening in the middle of the cycles where there were not tests, with a PS of 26. When the CG posted again, I suggested he lower the dose. It still seemed too high, and the next 0.25 unit reduction down the blacks went away. The cat did go OTJ not long after.[/QUOTE]

 

Bring ‘em on!

 

Ok... question #125

When you feed a cat kibble all it’s life, then get a diabetes dx and switch to pate (protein only or low carb high protein)there’s potential for setting them up for kidney disease ...primarily because we don’t know how long sugars have been high and what kind of damage has been done.....setting the kidneys up for failing down the road?
This is just from nursing experience..... with people not cats...... so would it be wise to give a teeny tiny bit of healthy carbs??? Thoughts???

 

No on the carbs. I saw a paper recently that said there is no higher incidence of kidney disease in diabetic cats vs. non.

 

I’d love to read that !! Would you share it with me??

 

Hi Suzi, she has linked it in the post. You can get it here:
https://journals.sagepub.com/doi/10.1177/0300985813516645

 

I printed the entire conversation for easy reference later!
Thank yiu