1/7 Poppy PMBG 92 AMPS 180, +2 162, +4 121, +6 81 / started 0.25u

Yesterday's thread: https://www.felinediabetes.com/FDMB/threads/1-6-poppy-pmps-76-amps-285-3-208-6-58.241079/

So I gave Poppy 0.25u this morning after AMPS was 180 (2 hours ago). Ate very well afterwards. Now at +2 BG is 162. She feels very well for the moment, just finished a playing and running session

Will leave home soon for a couple of hours and will give her a good treat just before I leave.

It's the first time I shoot such a small dose and it feels very strange when giving the injection. Don't feel the syringe releasing, as the quantity is so low. Not to mention the little air bubble that I never manage to get out of the syringe Hope I got it right

 

good idea.
I wish you had an autofeeder, even with george in remission it's a valuable tool to feed them regular snacks when you are out or asleep.

 

I will purchase one. Does anyone have the Cat Mate C500? Is it ok? If not, if you could give me some recommendations, it would be great.

 

Look at post #19 and 21 on this thread/condo
https://www.felinediabetes.com/FDMB...-369-4-375-6-390-9-339-pmps-389-4-399.240942/

 

I have the Trixie tx4

I like it, though some people have found their cats can break into it, George never has, nor his civies.
https://www.amazon.co.uk/Trixie-Plus-Automatic-Dispenser-Display/dp/B000V9I05C

 

The 0.25u dose seems to work well so far. Hopefully I will also get to give her the evening dose.
Feeding her small meals of integra lc after each test. She started to learn that after we test, it's feeding time

 

Hopefully she will surf with the +6. And then pop up a bit for ps.

I take it you are thinking of sticking with 0.25u.
I would do that even if she is high. It would be good to be able to shoot consistently.

 

Yes, I would stick with the 0.25. My only concern is that she will be too low again to shot in the evening. But the values seem more balanced then in the previous days, so I think she will rise until PMPS.

 

With SLGS, which you have indicated you wanted to follow for now, in theory she would have earned a further reduction with a drop below 90.
However, I would be reticent to take another reduction. With lantus the 1.00 dose you shot yesterday and the day before will likely still be influencing her cycles, (upto 6 cycles) so we don't usually take back to back reductions.

So as long as she is above 90(on SLGS you don't shoot below 90) I would shoot tonight, but keep it at 0.25u, even if she is high.

Although nadir in an active cycle is considered, for most cats, to be around +6, this isn't true for every cat and it can move around somewhat.
So if you are home and can test her at +8 and +11 today (more if you deem it necessary, you will see whether she has nadired at +6 or in fact is continuing to drop.
If you give her a snack after testing, (I always did with George/he loved them) I would perhaps avoid giving her LC food afte +6 and give her some carb free treats (if you have them/ or maybe a little snack of boiled chicken)

It is one of the things with lantus when you shoot low they don't tend to drop as much nor as fast as when they start from a high point. They often have flat cycles which is what lantus is famous for.

How are you fixed for monitoring tonight?

 

Personally, I think that TR will offer you the best chance to get her regulated, and quite probably into remission (antijinx), I think the food change has made quite a difference to her, but continuing insulin support for as long as it is safe to do so, giving the beta cells time to heal and become strong is what will more often lead to strong remissions that hold. Within a tried and tested framework. If you can find the strength/time to just hang in there with it, Poppy and you will reap the rewards of your hard work.
With SLGS I am afraid you will be taking reductions, skips and there's not a lot of room for maneuver with the sort of numbers you are getting, dragging the process out at best, or at worst coming OTJ too quickly, and finding yourself back here in a few months with a cat that is harder to regulate.

I know you have said you are worried you do not test enough. For TR if you test at PS and then a couple of tests (move those about) midcycle that should be enough for a normal cycle, though granted the next couple of days may require a little more just to see how she is with this dose, since we got to it unconventionally and there is the food change to keep in the back of our minds too.

What would be a reasonable number of tests for you to be able to do in a day, and still be able to get on with your work?




When a cat comes out of remission, it is quite often much harder to get them back into remission a second time. I have had to do that (steroid shot knocked him out of remission), and I had to approach TR from quite an aggressive standpoint, not an easy thing to do for everyone if you have other commitments.

 

For pet feeders, I have the CateMate5 and the PetSafe5 and far prefer the CateMate5. It's a smaller footprint, you can see all the times on the screen at once, and has ice packs. I do find the clock gets off by a minute every day or two but I just reset it. Additionally, I did find little sauce dishes to put inside mine though it's not necessary. I found these on amazon (in the US) - https://www.amazon.com/Dipping-Dish...7TFD6SQ8/ref=pd_sbs_79_2/145-2563536-8906642?

 

I am another vote for the CatMate c500 and I use similar dishes inside. I've had mine for about six months now. I'm thinking of purchasing a second so I can have one for the day and one for night since I haven't been able to find a second set of ice packs for it (I'm in Canada). That would be my only complaint.

 

@Gill & George During the day I am ok with testing as much as necessary. I work from home, I can have breaks any time. Poppy stays with me in my "home office" room, so I can supervise her.
I am more concerned about the night. I give her the shot at around 7:15 PM, and go to sleep at 11-12 PM. If I wake up during the night to check on her, I will most probably not sleep at all, and then it's hard with work the next day. I have a difficult sleep, meaning that if I wake up, I then fall asleep very very hard, so waking up at night, makes it impossible for me to rest the necessary amount of hours.

And then there are the weekends, when we need to solve stuff that we can not do during the week, so most of our Saturdays and Sundays we are not home between let's say 11-12 AM to 4-6 PM unfortunatelly.

Poppy dropping so much so quick, and not being able yet to adjust her dose in order to cover both cycles AM and PM, was a surprise and a quite tiring one. I am trying my best to offer her all the care and support I can.

 

@Butters & Lyla I got extra ice packs from the manufacturer but also just found them on amazon - here's the canadian link in case you want to look into it https://www.amazon.ca/ANI-Mate-Replacement-Pack-C500/dp/B07M6MVMGM/ref=sr_1_13?

 

I understand, and I can see you are, I hope you don't think I was suggesting otherwise. I am most definitely not.

I had a similar schedule to you I also did a 7am and 7pm, I was usually done with testing in the evening by +5 (midnight) sometimes earlier. I was usually available during the day for as long as I had to.
I don't have a problem sleeping so I could set an alarm and test and fall back asleep, so I can see that might be harder, the auto feeder will help you with that, so you can get to sleep in peace (I did that sometimes to, when lack of sleep caught up with me) you can leave snacks out for her to keep her safe.
Most times if I needed to go out of the house I would aim to test till +3/+4 and then I'd go out for the few hours I needed a trip to the supermarket for me is an 1hr30min round trip, not counting the time spent in the shops. My DH was working abroad at the time, so again weekends were harder because we just needed to get stuff done. I would walk the dogs for an hour or so at around +9 sometimes earlier sometimes later.
I did it from November to April, we had to get right up to 3u before he started coming down the ladder (that is when it was most tiring and needed most monitoring).
I don't know what the future holds in store for poppy, but my gut (and the SS) is telling me that, having made the food change, she's got her eyes on going OTJ and I want to give you the best advice to get her their quickly and have her stay there. I don't want to see you loose this opportunity.

That was my only intention in my previous comment, not to make you feel bad, I'm really sorry if it made you feel that way.

From what you have said with regards your availability to monitor, you really would be able to gather enough data to allow you to do TR.
We have members that are out of the house for long shifts, who are still able to do TR, they may take the dose increases a little more cautiously, waiting to gather a little more data if necessary before taking a dose increase, skipping a shot if necessary.

You can also use food to bump her numbers up, using some MC or HC food, not because she is low, but just to abort the cycle if she is lower than you feel comfortable if you are leaving her.
I did that by leaving snacks of MC or HC in the autofeeder at hourly intervals so George would have a feast whilst I went to the shops. I would test at +2, decide what food to leave... and he would get a snack as I left then another at +3+4+5+6 .

Once you start shooting regularly, we should start to see the patterns in her regular cycles.

You can start with TR and if it's too much you can come back to SLGS, it's not set in stone.
I (and the rest of the group) will support you with whichever option you choose to follow, you hold the syringe, you are there with her.
Bless you for taking her in and doing all you are doing for her.

BTW How is her Wound?

 

@Gill & George Yes, I understand your intention and I appreciate every advice each of you give us

I just look at her spreadsheet at the last few days with all the changes, and I feel that I made the right choice by not giving her the PM shot. I mean, just looking at yesterday, I imagine that she would have gone into hypo at night if she received 0.5u (instead of skipping). Maybe I am wrong.

The decision to go even lower, to 0.25u this morning, was sugested by Elise when she saw her PMGB +9 value. So what value would she have had at PMGB +9 if I gave her yestarday evening 0.5u instead of skipping? Wouldn't have she gone into hypo?

This is why I am not still confortable with the TR, because her values are quite low with much risk of hypo, and I don't think she has been monitored enough to know for sure that 0.25u or 0.5u would not get her into hypo when her BG drops below 90. I am not speaking about tests per day, but days since her values dropped constantly, even if I skipped so many evenings and I lowered her dose at the same time. Maybe it's the inconsistency that influences these values and the food changes but I am unconfortable to take the risk at the moment when I see these values and I have so little space of maneuver.

The wound looks the same, but she has moments during the day when she is still licking that spot compulsively Still waiting for the Kattovite Sensitive canned food to be delivered, and hope it will make a difference. Might be hard to give her treats and different kinds of brands if she responds well to the single protein food change The vet also recommended Salmon oil. I ordered it today together with the CatMate c500 feeder.

 

That was a good decision. I think given you shot that it's a good idea to try to stick to it, if you can and it is safe, unless the numbers tell us otherwise. I suggested shooting 0.5u if she was above 100 (blue), as that would have told me she was well into a climb, given the numbers where she was coming from. The 91 she gave you was a difficult one to judge, she stayed flat with food, that cycle, with the 1unit dose (which I think is too much for he at the moment) was still influencing that cycle for sure) I was OK that you decided to skip. There were too many unknowns, and we want to avoid throwing you in the deep end. Had you shot, you and Poppy would have been fine, and I would have stuck with you until she was. Guiding you through the steering if her numbers dropped.


She probably would not have had a hypoglycemic event, we've seen cats given a one of dose of Lantus of 5u instead of 0.5 (when a petsitter has made a mistake for instance) that haven't resulted in the cat having a hypoglycemic event. George for instance can test in the 40's now he is off insulin altogether, that 50 cut off does not mean that they are hypo, it's a cut off point for safety. But you may or may not have had to steer with food. Can't say, just because she nadired at 80 today doesn't mean she would have nadired at 40 on double the dose. If you had shot the 0.5u, you might have had to use some higher carb food, but equally it might not have been necessary.



George when on insulin got as low as 27 (once) had no symptoms whatsover, so he did not have a 'hypo event' he had a low BG level. Hypo would imply symptoms. Was it scary, absolutely, also was my fault, in that I was a newby and gave MC instead of HC when he dipped just below 50 early in the cycle, I let the cycle get away from me, I did not make that mistake again.

I agree wiith a lot of your observations.
With the food changes and dose changes we do not know where she is at. Hence going to the 0.25u dose that Elise suggested in the morning, we may yet find that it is not enough or indeed it is too much, only time will tell.

The inconsistency with the dosing is affecting the values/curves, it gives us wonky numbers, another reason we don't know if the 0.25u is not enough or too much, for every Lantus dose there is a depot that is porportional in size to that dose, when we take a dose up the depot gets bigger, it takes upto 6 cycles to stabilise, as we take the dose down it takes upto six cycles for the depot to reduce in size and stabilise, during which time the larger depot may still be influencing the numbers.

With TR we don't all start shooting in the 50's the first time we come across a low BG we work our way to shooting lower until we are comfortable with it. It's perfectly acceptable, in the begining (which is where you are) to think of what the lowest number you might be comfortable shooting would be, let's say that was 90. We can work with that. If you were doing TR lets say she was 60 at +11 and you got a 89 at PS you might feel happy to shoot, she is rising, you are feeding, so BG will go up with that too, it indicates the duration is over, however if you are doing SLGS, you would not shoot below 90, you would have to skip.
Often we focus on the absolute number we are seeing at PS, but we have to look at in context of the curve.

For example I would be more concerned if she gave you a 92 at PS but a +11 was 140, not that I wouldn't shoot, just that I would be thinking that the cycle is likely to be lively if I shoot. More likely to be lively than if she is flat or rising by PS.

You are of course absolutely right you do not have much data, now that she's gone off the dry and she's in lower numbers, and it is something to take into account when deciding whether to shoot or not.

You have shot 1u on a 109 a little while ago (to what looks like a falling PS) so maybe 100 would be your cutoff point? or if you want to go with 90 that is fine too.

I see she has dropped to 70 at +10, that might be the lantus double dip. Let's see what she does next.

 

poor little thing.
There are single protein treats that you can get freeze dried, pure meat or fish, nothing added (lamb, chicken, pork, wild boar, salmon, tuna ) they are Low Carb too, all my cats love them, one of them refuses to eat his proper food unless I sprinkle some crushed up treat on it then of course if the others see that they want some too. (I'm a sucker, they have me well trained)

I can't remember if I said but Ferringa do a pure meat range with single protein, chicken, lamb, veal, duck as well, they are on the list (my cats get these on rotation, but they have got things added like pumpkin and squash). Also Granata pet do some single protein chicken (but they have salmon oil added)(I use this one too). Thrive also do some single protein stuff, pure shredded chicken, and tunaflakes and a whitefish one(George is a huuuuge fan of the Tuna). There are options out there. I struggle, with foods, not because of allergies, but to do with CKD, so I have to try relatively low Phosphorous with LC ( a kidney diet would be too high in carbs for George), so it limits his choices.
Integra do a sensitive range and as well that is single protein(haven't tried this one) The UK list highlights the single protein options.

Salmon oil can be an allergen for some cats, though it does have anti inflammatory properties. Maybe change one thing at a time, to help you figure out if something is helping or not.
I've seen some good reviews for the Kattovit Sensitive both for cats with skin allergies or gastrointestinal allergies. George has this one and loves it too, it's one of the few options that is also below 1% Phosphorous.

I hope the new food is a hit with her.

 

She's not making it easy.
That was a very late nadir.

Interested to see where she will go later on in this cycle and where she will be in the morning.

 

Nice numbers last night and green again this morning!
I hope she stays green all morning
Looks like getting rid of the dry is working really well for her. Keeping all paws crossed.
I would see how her numbers pan out today and tonight. All being well, if she is green tomorrow morning. How do you feel about starting and OTJ trial?

 

@Gill & George, yes she seems to be doing really well. If she stays like this, starting OTJ trial is the natural thing to do

She doesn't seem to be influenced by food so much anymore. Last night she ate at PMBG, then again at +5, and had a snack at +7, and she managed to stay green all this time. All lc food, of course.

I will start a new thread soon.

 

Cats on diabetic remission will do better on small regular meals, I tried every 4 hours and every 3hrs, George does better with 3 hour snacks, BG remains lower, if he skipped a meal his BG would climb.
The regular meals are easier on their pancreas.
paws crossed