1/7 Henry AMPS 122 should I be drop dosing?

Discussion in 'Lantus / Levemir / Biosimilars' started by Angelaf44, Jan 7, 2021.

  1. Angelaf44

    Angelaf44 Member

    Joined:
    Dec 30, 2020
    Hello everyone,

    Henry's last insulin dose was 01/05/2021. He has stayed mostly green since then although his AMPS is always blue.

    Wanting to ensure a strong remission, I am wondering if I should be drop dosing twice daily to get him fully green. Maybe just in the mornings? I'm not sure I'm comfortable shooting him at night when his PMPS is green. I want to be consistent with his insulin but I'm finding it difficult with the swings from green to blue.

    Henry is a newly diagnosed diabetic and I don't have experience shooting low numbers or a lot of data on him yet. I try to test as much as I can to catch trends but I'm at work during the day, so most readings are at night. Weekends I can get readings throughout the day.

    Previous thread:
    https://felinediabetes.com/FDMB/thr...-could-use-some-help-with-fine-dosing.241013/

    Henry's SS
    https://docs.google.com/spreadsheet...itnqaaiZOn2OhwhBBwKsv5XSsSE/edit?usp=drivesdk

    Thank you!
    Angela & Henry
     
  2. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    On the surface it would look like he needs some insulin support.

    In the previous thread you said he almost off all the dry.... How much is he getting?
    I would use that minimally and if you can scrap it altogether.
    This is interesting. It suggests that his pancreas is working, I can see it happening in the evening when he hasn't had a shot.

    Is he getting regular snacks in the day?
    Could mum be forgetting or giving too much? (you know cats they quickly convince someone they are starving and will convince them to break out the kibble, because nothing else will do)

    Maybe you could start doing a drop dose on friday night and through the weekend to see how he does, when you are at home and are able to monitor?
    If between now and then you could scrap the Dry as well.
    If you want a strong remission I would get rid of that, it's not one of the ones that I recognise as LC (so it's likely above 10%)
    Once a diabetic always a diabetic, and even in remission we need to keep them on a under 10% carb diet.

    Also you may want to read this post and the links in it discussing zero carb versus some carb, zero carb is not always the best choice for some cats.

    https://www.felinediabetes.com/FDMB/threads/feeding-lowest-zero-carb-vs-lower-carb-foods.144220/
     
    tiffmaxee and Suzanne Burton like this.
  3. Angelaf44

    Angelaf44 Member

    Joined:
    Dec 30, 2020
    Hi!

    He's getting very little dry, maybe 1/8 a cup. Only reason this is even happening is I have another kitty who will only eat dry, so Henry eats the few leftover kibbles from dry only cats' breakfast. I've taken to waking up a half hour early and feeding everyone separately so I can remove whatever is leftover before I go to work. It is definitely not a low carb dry, it's 17.2%. I never realized how difficult it is to feed a 3 cat household when everyone needs to eat separately until last week.

    He gets one snack midday, low carb canned I have pre measured for my mom to give. We just started the midday snack a day ago however.

    I share your thoughts about starting the drop dose Friday night so I can watch him, that was my plan as well. If eliminating the dry keeps him in green consistently, should I still even administer the drop dose?

    I'll read the post now, thanks for linking it. He's been eating Tiki canned for years because he loves it, I didn't select it for the zero carbs- just lucked out it happened to be suitable. I am going to switch to something with a few carbs though, staying under 10%. I tried a 4% Merrick can yesterday which he loved (he'll really eat anything I give him though.)

    I really appreciate your help, thank you!
     
    Last edited: Jan 7, 2021
  4. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    No need to take him off it if he likes it, it can be one of his food choices if he loves it.

    See what happens with his BG.

    Tell me about it, I usually have my first coffee of the morning whilst supervising breakfast for my 4.
    George has his low P, LC food, Felix has LC with his BP tablet, the other two have LC, but I have to watch them like a hawk otherwise they start swapping dishes.

    If you can't get you other cat of kibble, maybe you could look to swapping him onto a LC dry (there are some available in the US) then it shouldn't be as much of a disaster if Henry gets a few pieces.

    Have you seen Scooters SS (look at feb 19 2014), it's a cat who was on 5u of insulin and eating a LC wet diet, in the household there were some other cats who were eating kibble, CG removed all dry from the household and in the space of 24hrs went OTJ. Linda was sure he couldn't be getting much, but it was enough to make a huge difference to him.
    Here is the link to all the action on the condo
    and another one that also highlights the difference that dry can make.
    Here is Spiders SS CG got rid of dry 6/4 to 6/8 and was OTJ by 6/15

    My own experience with George is the same, while on remission, he got into some of the feral/farm cats kibble when my petsitter was looking after him, she didn't think he would be able to jump onto the windowsill and get to the kibble, anyways he did and his BG went to black. Thankfully he came back down when it worked itself out of his system.
     
  5. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I agree with Gill, if you could swap over your other kitty to a low carb dry food it wouldn’t be as bad if Henry managed to grab some.
    Even small amounts of dry can make a big difference to the BG.
    I had another cat, Maxie who was not a good eater and I had to feed him dry sometimes to get him to eat. No matter how hard I tried, Sheba would somehow manage to get some of his dry food every so often and it always reflected in the BGs.
     
  6. Angelaf44

    Angelaf44 Member

    Joined:
    Dec 30, 2020
    I went out and bought Dr Elsey's Complete Protein yesterday as it was the lowest carb dry I could find, under 10% apparently. Have a bag of Ziwi Peak on order too which is even lower carb.

    I decided to give Henry a drop of insulin yesterday evening as his PMPS was 8.5 (153) and he went all the way down to 2.9 (52) just three hours later. He was acting normal, but I panicked and followed the low numbers guide on here & fed high carb and retested frequently until I was satisfied he was up.

    Any idea why a drop would throw him into the danger zone? There was next to nothing in the syringe, the plunger was all the way down. I tested this method multiple times and never more than a tiny drop was dispensed. Glad I did this when I was home to monitor.

    I think I'm done with insulin at this point. All traces of dry have been removed, starting fresh today to see if I can control him on a strict diet. Yesterday evening shook me.

    I'm open to any and all advice from you and tagging @Gill & George. Thank you for your advice yesterday! You have the multi cat dilemma too! I wish watching all three like hawks worked, I need to put them in separate rooms otherwise no one eats what they're supposed to. I'm going to read through all the info & links you posted now.
     
  7. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    I don't know if he's ready for a trial. He doesn't look conventionally ready with those blues and a yellow a couple of days ago. We usually start a trial on a Green ambg/pmbg
    How long was he on the Steroids for before you realized he was diabetic? When were they stopped? were they injections or tablets?


    Temptation treats are very high carb, I'd clear the house of those too.
    Let's see what he does with all the HC out of the house.
    On a complete LC diet we know he is ready for a trial if his cycles are mostly all green. We are not seeing that, the picture may be muddied by the dry HC he's been having, and the HC you gave him last night to bring him up, he wasn't in danger last night, he may have just surfed for you, he wasn't dripping fast from +2 to +3 some LC might have done the trick.
    This mornings 147 and then him still being in the140's two hours later makes me think he may still need some insulin support, I'd have been much happier if I saw him drop a few hours after his food, as that would suggest that his pancreas was awake and working. With the temptations last night it maybe that they are not fully out of his system and that's why he's not going green, not sure how likely that is.

    If he is still in the mid blues tonight or higher.
    With dry out of the picture, and you getting rid of the HC dry in the house, maybe you could follow TR for tonight and the weekend, see if you can get him all green for the weekend, ideally I would want to see him all green for a week before taking him of insulin altogether, but I understand if you feel that you don't feel comfortable with that during the week. With TR you would take a reduction if he dropped below 50, the idea however, over the weekend would be to keep him on that drop of insulin, using LC food, maybe MC.
    Then see where he is at on Sunday night and go from there for the week ahead, it may be that with the data you gather over the weekend and seeing his response to food that you feel you can keep him on a drop.
    But you don't have to decide until sunday, and at the end of the day the decision will be yours as to what you are comfortable with.
    If you don't try it this weekend and he continues to give you blues, you might find yourself chasing those raising BG's and it could set you back. Being a little bit more aggressive now may help to get him regulated and OTJ and have it stick.
    Look at Georges SS, you will see what the numbers of a cat that is ready to go OTJ looks like. April 2016. (I was only feeding LC with those numbers).
    I know it's going to be harder for you to take that leap of faith because you feel you haven't got the data to support it, he has only been diagnosed as diabetic for a very short time.

    If he is green or in the very low blues
    Then play a wait and see game. Lets see if he can come down to green and stay there on his own. This is advice tailored for you and Henry, given the combination of circumstances we have, very newly diagnosed, unconventional dosing, dry food just removed, steroids only recently stopped.
    If you play this wait and see game it's goin to be important to monitor over the next week, just as you have and if he doesn't come into normal numbers you may need to restart next week anyway, to try and grasp and hold to a strong remission.


    George was knocked out of remission by a steroid shot given to him by the vet, have a look at the 2019 tab, it took 10 days for it to work out of his system. I managed to get him back OTJ but it was harder that time round. You might find it interesting to see how that affected his BG, he had been in remission, nearly always testing green for over 3 years at this point.

    Then we had an accident, I had my civies on some dry food whilst they were at the kennels whilst we were on vaccation, I picked them up and DH left the bag with the kibble in the hallway, I realised he'd eaten some, you can see it sent him onto the yellows, 4/13 I waited to see if he would come back down, in the end I had to restart insulin. I started with 0.1u and supported him with that for a while then we took a reduction to a drop, and eventually went OTJ by endo of May.
    Again another illustration of how HC dry can really throw a spanner in the works.

    That shows you what steroids and HC food can do to a cat that's in remission, I was able to get him back there, but I was on it straight away, I didn't wait too long before restarting insulin.
    That's better I would keep henry on a purely wet diet and avoid him having even the LC dry on a regular basis, we have seen cats here that do well on the LC dry, but others have found that they have had a problem with BG when feeding the LC dry and cat's have done better when they made a swap to an all wet LC diet. But in your situation at least it won't be such a big deal if he sneaks a piece.
     

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