11/13 Tiny Solè: AMPS:117, +2:169, +6:85, +7:116, +9:165, PMPS:105, +4:99, +5:111, +5.5:122, +6:132 | Feline Diabetes Message Board - FDMB

11/13 Tiny Solè: AMPS:117, +2:169, +6:85, +7:116, +9:165, PMPS:105, +4:99, +5:111, +5.5:122, +6:132

I'd appreciate getting some examples of how you've helped your kitty surf in greens while guiding them towards the ultimate goal of OTJ.

At what number do you begin to give them a small LC snack? I recall reading that a snack is given when they go below 90 to help them surf safely, but I wonder if that can be adjusted to see how flat they stay?

She gets a snack around the +9, since she usually starts to nadir at the +9 to +11 and the +9 is a safe time to give her a snack two hours before her pre-shot numbers. But I'm wondering if I'm giving her a snack too often throughout the day. ...she eats a decent LC meal (2 full Tbs) just prior to her AM + PM doses, then a small snack (1-2 tsp) between 11 AM and 1 PM, then the same snack around 4:30 PM, before bed at 9:30 or 10:30PM, then 3 AM. Its always LC FF, unless her numbers are below 80. Too much snacking?

Your thoughts?
 
It really is an ECID kind of thing and with much experimenting with meal timing .And during the green cycle depending on the number and where it lands in the cycle, would determine whether you give some LC or MC or HC food. On 10/31 AM cycle, you helped her surf in the greens through the rest of the cycle. :) Once they get more used to being in greens they will stay there a bit longer and the cycles start to flatten out.

As far as food timing, I give 6 meals a day to Bubba and they are equal sizes only because it's easier for me to not have to think about portion control all day. :rolleyes: The best thing to do would be to look at the SS numbers with those feeding times in mind and see if she is being hiked up right after those feeding times. With some kitties if you feed after nadir it puts the brakes on the insulin but with Tiny being a late nadir kitty you have more flexibility with the feeding schedule.

I wish I could give you a formula for how to have them surf but there isn't a "one size fit's all" answer. As you get there and need help, peeps will help guide you and once you do it you will get a feel for it and use that info the next time. I put the food I use and % in the cell with the test number. That helped me see how he was responding to the food.

I am glad you got some sleep last night. I got 5 hours in a row and awoke at 4 AM and had trouble getting back to sleep. :rolleyes:
 
Bobbie And Bubba said:
I got 5 hours in a row and awoke at 4 AM and had trouble getting back to sleep. :rolleyes:
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Oy. Sleep eludes us.

Thanks for the info on snacking. I guess I'm concerned that I'm giving her too many snacks throughout the day, so maybe isn't consistently traveling down the green path as a result.
 
Tested before I went to work this morning:
+2: 169
+6: 85
...after my work meeting when I stopped home. She gobbled, waited 7 min, then vomited it all up. I will give her 10 to 15 min to recoup, test her again and give her something else.
 
Good ideas. I think I'll give her little bits on a tablespoon so I can slow her down next time. Thanks for the suggestions, Sue. ❤
 
Joanne, you decreased to 1.125u the other night and yesterday AM and then it looks like you went back up to 1.25u last night and this morning or is that a typo? Just curious.
 
Joanne&TinySole said:
At what number do you begin to give them a small LC snack? I recall reading that a snack is given when they go below 90 to help them surf safely, but I wonder if that can be adjusted to see how flat they stay?
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The rule of thumb on a human meter is to give a couple tsps LC when they first hit green. So that would be higher than 90. And we can't exactly say what that would be with an AT as there is no direct comparison, though AT's as a rule are a bit higher. Of course there are exceptions. I think that is where you have to figure out a number than works for Tiny. As a general guideline, you don't want to feed many if any carbs after nadir, unless you are deliberately trying to bring up their numbers. My Neko used to nadir somewhere around +7 to +9 (unless she didn't) when on Lantus and I typically gave her a +8 or +9 small very low carb snack.

As far as number of snacks are concerned, are you weighing Tiny Sole regularly. Any chance she's getting less than tiny? :p I would use your scale as a guideline to get her to a desired weight and how much/when to feed snacks.
 
MrWorfMen's Mom said:
it looks like you went back up to 1.25u last night and this morning or is that a typo
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No typo. I went back up. Although she earned a decrease, I didn't feel like I held the dose long enough. I'm going to stay at 1.25 a bit longer. She's earning decreases daily, but my logic says that she isn't having consistent greens to REALLY warrant the decrease. She's steadily in the blue with a green here and there, but not staying there.

Your thoughts?

I know you tell me I'm doing well, but I'm still struggling with whether or not im making the right calls. She's earning nearly back-to-back reductions, but I understand that B2B reductions don't hold and we need to see consistent greens to get her OTJ, if she can even get there. So she's threatening greens, and teasing greens, but the snap that put her into the consistent flat blues she's experiencing absent happened yet for the greens.

I don't want to push her to green before she's ready with higher doses, but I don't want to lose the opportunity with lower doses either. I'm still learning how she'll respond, so my logic said "no reduction (I questioned it when I gave it) until I see more consistent greens."

I have no idea if that is a sound decision or not to hold the dose longer, but intuitively it seemed to be.

Thoughts?
 
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I hear ya and agree that she has been demanding a lot of reductions. You may want to consider switching to TR which would lower your reduction point to 65. It means she's not going to earn reductions as quickly and you may see the dose wobbling a bit while trying to attain reduction level BGs but it may also be the ticket to getting Tiny to surf along in low blues and high greens and who knows... maybe remission.
 
MrWorfMen's Mom said:
I hear ya and agree that she has been demanding a lot of reductions. You may want to consider switching to TR which would lower your reduction point to 65. It means she's not going to earn reductions as quickly and you may see the dose wobbling a bit while trying to attain reduction level BGs but it may also be the ticket to getting Tiny to surf along in low blues and high greens and who knows... maybe remission.
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Ok, is that 65 an AlphaTrak2 meter number, or a human meter number?
 
That's the AT2 reduction point. Human meter is 50. From what you described, I don't think the amount of kibble Tiny consumes amounts to anything more than odd pilfering which many of us have had to deal with so I don't think it should preclude you using TR.
 
MrWorfMen's Mom said:
You may want to consider switching to TR which would lower your reduction point to 65.
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Note: FWIW, the AT2 reduction point when following TR is 68 (set by Dr. Jacquie Rand), not 65 as stated. Not a biggie, but it's not 65 either.
Joanne&TinySole said:
Ok, is that 65 an AlphaTrak2 meter number, or a human meter number?
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MrWorfMen's Mom said:
That's the AT2 reduction point. Human meter is 50. From what you described, I don't think the amount of kibble Tiny consumes amounts to anything more than odd pilfering which many of us have had to deal with so I don't think it should preclude you using TR.
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Bobbie And Bubba said:
I agree with that statement.
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Note to those following... a disclaimer: This advice and confirmation of that advice is contrary to the guidelines written by the creators of the TR Protocol used on this forum:

Short version from the sticky - Requisites when following a Tight Regulation Protocol with Lantus or Levemir:
  • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
    More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
  • Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Although, some kitties will adapt well to free feeding.

Long version from the Tilly's Diabetes Home page:

• this protocol was developed by lay people, including myself, who are members of the German Diabetes-Katzen Forum. It has since been published in the Journal of Feline Medicine and Surgery.
• the majority of cats do very well on this protocol, some cats do not (generally these are hard-to-regulate cats)
• it is more time-consuming than most other protocols, but still definitely doable if you work a regular full-time work week
• it is more expensive than most other protocols, but costs can be reduced by e.g. buying glucose test strips from online pharmacies or reputable sellers at eBay
• members of the German Diabetes-Katzen Forum buy 3 ml Lantus/Levemir cartridges, refrigerate them after opening and routinely use them for 6 months or more - when refrigerated, opened cartridges of these insulins are extraordinarily stable
• you will need to test the blood glucose levels of your cat multiple times per day
• you will need to know about hypoglycemia and be prepared to deal with it
• you will need to test for ketones regularly to start with and know about ketoacidosis, but be aware that ketones don't occur once a cat is (and remains) properly regulated
• you will need a brand-name glucometer made for human diabetics that measures whole blood (not plasma-equivalent) and which uses 0.6 µL of blood per test or less
• you will need to use syringes which allow you to measure tiny doses: U100-type, 3/10 cc = 0.3 ml volume and with the half-unit printed on the barrel
• you will need to feed the right diet: high-quality low-carb canned food or raw food exclusively
• you will need to feed your cat lots of small meals spread over the day, free-feeding canned food can be an option for some cats

The requisites were not only written by the creators of the protocol, but they were based on their experience following it. With all due respect, the advice to circumvent any of these guidelines is limited to the experience, thoughts, and assumptions of those offering it today. Anyone following along should be aware of deviations from the normal and accepted course of action.
 
We are in the same boat as you Joanne. Bubba eats such a teeny amount of 0% YA dry food ( it's really considered a trace amount and is < 1%)
Before today, he hadn't had any I believe since 10/7 ( 1 tbsp.) Tonight he refused all food, raw , canned, baby food, and poached chicken, so he got 1/2 tbsp. for his AM +6 meal. ( Yeah, he ate it! ) I know that it is against the protocol for safety reasons , but I will continue to follow TR and not switch to SLGS because of that scarce amount. I take all responsibility to the safety of my cat. No one is responsible for my actions and I take all responsibility for the safety of my cat.
 
Bobbie And Bubba said:
We are in the same boat as you Joanne. Bubba eats such a teeny amount of 0% YA dry food ( it's really considered a trace amount and is < 1%)
Before today, he hadn't had any I believe since 10/7 ( 1 tbsp.) Tonight he refused all food, raw , canned, baby food, and poached chicken, so he got 1/2 tbsp. for his AM +6 meal. ( Yeah, he ate it! ) I know that it is against the protocol for safety reasons , but I will continue to follow TR and not switch to SLGS because of that scarce amount. I take all responsibility to the safety of my cat. No one is responsible for my actions and I take all responsibility for the safety of my cat.
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No, Bobbie. You're not in the same boat.

"... still giving some kibble for free feeding" is not the same as "Before today, he hadn't had any I believe since 10/7 ( 1 tbsp.) Tonight he refused all food, raw , canned, baby food, and poached chicken, so he got 1/2 tbsp. for his AM +6 meal."

There's a BIG difference between "giving some kibble for free feeding" and a cat who has "refused all food, raw , canned, baby food, and poached chicken...". In Bubba's case, you've chosen to feed some kibble when other options failed. "Giving kibble for free feeding" is not an occasional last ditch effort to get a cat to eat something... anything. I've done the same. Who hasn't? Sometimes eating something... anything... even a little bit of kibble will entice a cat to eat.

Moving on from there... we're again at a point where suggestions made to other caregivers should follow guidelines. There are tried and true reasons for those guidelines. In the 12+ years I've been here, there haven't been any accidents when those offering advice follow the suggestions and guidelines in the protocols. I hope you can say the same 12 years down the road.

I just don't understand what's going on here any more. We have people bending rules because of "what they think". We have people who have zero experience with certain insulins providing all sorts of advice in every forum. We have people whose spreadsheets tell a sorry story, but newbies don't have a clue. Someone recently likened it here as becoming the Wild, Wild West. That's sad when we're dealing with kitties lives. Really sad. I am so disappointed. The very least we can do is offer tried and true practices and guidelines.

Stepping off the soapbox now...
 
I agree with Jill 150%. I’ve been in and out a lot since my mom passed away and every time I come back, I am stunned at the advice given to newbies and how often it misses the mark.

It’s almost a “here’s the TR protocol or SLGS method and you can change it where you need to for your cat” attitude with new members. Yes, once a CG has more than adequate data; knows their cat; understands onset, nadir, duration, carryover, and overlap; knows how their kitty responds to food, etc, then modifications are fine although dry should not be fed for TR protocol except as Jill mentions above.

However, starting out, how can a CG know if either method works to regulate their cat if they don’t follow the guidelines?

Sorry to hijack the condo......and I’ll get down from Jill’s soapbox ;);):)
 
Jill & Alex (GA) said:
No, Bobbie. You're not in the same boat.

"... still giving some kibble for free feeding" is not the same as "Before today, he hadn't had any I believe since 10/7 ( 1 tbsp.) Tonight he refused all food, raw , canned, baby food, and poached chicken, so he got 1/2 tbsp. for his AM +6 meal."

There's a BIG difference between "giving some kibble for free feeding" and a cat who has "refused all food, raw , canned, baby food, and poached chicken...". In Bubba's case, you've chosen to feed some kibble when other options failed. "Giving kibble for free feeding" is not an occasional last ditch effort to get a cat to eat something... anything. I've done the same. Who hasn't? Sometimes eating something... anything... even a little bit of kibble will entice a cat to eat.

Moving on from there... we're again at a point where suggestions made to other caregivers should follow guidelines. There are tried and true reasons for those guidelines. In the 12+ years I've been here, there haven't been any accidents when those offering advice follow the suggestions and guidelines in the protocols. I hope you can say the same 12 years down the road.

I just don't understand what's going on here any more. We have people bending rules because of "what they think". We have people who have zero experience with certain insulins providing all sorts of advice in every forum. We have people whose spreadsheets tell a sorry story, but newbies don't have a clue. Someone recently likened it here as becoming the Wild, Wild West. That's sad when we're dealing with kitties lives. Really sad. I am so disappointed. The very least we can do is offer tried and true practices and guidelines.

Stepping off the soapbox now...
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I'm taking everything you have said to heart. Never would I ever want to do harm to someone's kitty. Ever. Or have you feeling disappointed in me as I don't think Bubba would be alive had it not been for you and Libby and your guidance.

I need to be transparent and say that prior to Oct 7th Bubba got a tbsp of YA every night at 2 Am. I truly felt that my own experience with using YA daily and not seeing that it interrupted anything in the cycle or caused any dangerous issues enabled me to share with Joanne as I believe her free feeding is about the same quantity of dry left down at night time only. But, I could be wrong about that and shouldn't speak for Joanne.

I just saw Margie's post and I'm glad she addressed the tweaking of the protocol but distinguished that only AFTER understanding your kitty's reaction to insulin and how their cycle runs with onset, nadir, duration etc . Good point.

I'm looking like a rule breaker. :oops:
 
Now it's my turn to hop on the soapbox for a while. First, I agree with Jill and Marje about what I've been reading lately. I would have said it's like the wild west out there, but Jill beat me to it.:p

A very important read for anyone here is a post entitled Suggestions for Advice Givers. My favourite line from that document is "above all, do no harm". I know there are times that I feel I am suggesting a conservative approach, but for me it's all about safety of the cat. I've been here when someone is suffering the consequences of not reducing when they should have and letting the depot get ahead of them. And it's the caregiver as well as the cat that are affected and I worry about them both. It can be a long exhausting battle to stay ahead of the numbers if you don't respect the depot. I have seen someone fighting the depot for over a day and a half. Unless there are extenuating circumstances (such as completely removing kibble, cat with secondary condition like acromegaly or insulin antibodies), following the guidelines of whichever dosing method you are using will keep you safe.

Always remember that ECID is more than an acronym. Each cat (and caregiver) is different. What might work for a caregiver with 3.5 years of experience, might not work for someone following a different dosing methodology and not even one month of normal numbers on the spreadsheet. Proceed with caution first, gather data, then let the data show you the way to go.

(off soapbox)

Surf safe tonight please Tiny.
 
+5.5: 122 at 12:30 AM

She's rising fairly well, so I'm going to set an alarm and test her in an hour, to be sure she's ok. Then as long as she's rising still, or stable, ill set an alarm for 2 or 3 AM.
 
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