How to proceed with Loki's dosing

Here's the previous thread link, and any previous thread before that is linked at the top of that thread, and so on.

https://www.felinediabetes.com/FDMB/threads/new-thread-for-dialing-in-on-lokis-dosing.272701/

@Bron and Sheba (GA) and @FrostD

Hey y'all, just checking in. If someone could look at Loki's SS, and see how we are doing with dosing. He has been bouncing for a few days, but if I'm counting correctly, today's AM cycle is the 8th after his last bounce break. That's at least how long it's been since seeing any blues. Normally we count in 6 cycles for a bounce right? So I'm not sure what to make of this. It seems the 0.75U makes him drop lower each time after a bounce break, and so we are hanging at 0.5U. I feel like I would be told to increase to 0.75U at this point, but I was wondering if I should see how he does continuing with 0.5, instead of messing with it again?

I know we need to keep his recent DKA in mind, and make sure he's getting enough insulin, but he went to the vet on Thursday, and his ketones were 0.7, which is great. He's remained consistent with that so far. His appetite is great, and he is like his old self these days.

Thanks a lot!

 

Hi Lauren, yes I do think you need to increase the dose. We need to get rid of those black and red BGs
You might just need to feed some higher low carb…around 7 or 8% around +4 to keep the BG from dropping too low.
That is really good there are no ketones and he is like his old self. Excellent news.

 

Yep, increase!

 

I think a fairly good indicator lows are coming is the yellow preshot. So, on those cycles you might consider what we call a skinny dose...just shy of the normal dose. Can also think of it as a 0.1U reduction off normal dose. It might help keep from going too low, but also allows you to keep dose higher on the bouncing cycles.

Obviously if that trend changes we'll have to reconsider: i.e. if he starts dropping from pink to green and is less predictable

 

Thanks Melissa,I wasn’t sure if you were going to be around or not. Glad you were!

 

Hey @Bron and Sheba (GA) and @FrostD ! Thank you. I have the higher low-carb food from the last time we talked about this. The food part is what wound up confusing me last time. So, to make sure I got it:
I am going to increase the dose to 0.75U tonight.
Then, at his first snack time around +4, starting tonight, I should feed the 7-8% carb food OR should I wait to see what his numbers are doing?
Also, do not feed this food all the time, correct? So his main breakfast & dinner meal should still be regular low carb? What about his later snack times at +6-8ish?
And then do NOT feed the higher low-carb food if it becomes apparent that he is bouncing, correct?
I know it might be hard to predict, but I want to make sure I get the schedule correct, and know when not to feed that food so I don't complicate things.

Melissa, that's a good idea about giving a skinny dose with those yellow preshots. Did not know that was an option. All kinds of tricks! How would I mark that kind of dose in the SS?

 

Hi Lauren you would just put the word skinny

 

@Bron and Sheba (GA) @FrostD

I have several questions in this post.

You can look at Loki's SS and see what happened. The 0.75U dose was bringing him down nicely, finally a blue. But with his tendency to drop fast with this dose, I fed the higher low-carb food at +4, as suggested. An hour later, he was up 100 points, and it just kept going all the way to HI not long after. The food was Nulo Turkey & Halibut, and it's marked as an 8% carb food on the 2017 Food Chart. I only fed about 2/3 of a can.

I can't help but feel frustrated. Should I not have fed this much? Maybe less next time? Or maybe this food is not actually a higher LC at all? I have a ton of different kinds of higher LC food now, and although they are marked higher LC on the Food Chart, some of the ingredients make me question that fact. Feeling overwhelmed, and upset about the food. It's like how do I really know I'm giving a higher LC food with these iffy ingredients, even though the chart says it is. UUGH!!! What am I missing?

Which btw, even if a food is marked 7-8% carb, or even 9-10%, are there certain ingredients that should always be avoided, regardless of the carb %? Such as wheat gluten, guar gum, tapioca starch, carrageenan, rice, etc. Should I only be getting higher LC pates?? I made a list of all the 7-8% higher LC food, and bought a few of each kind in case he didn't like some. And this one made him spike like it was FF Gravy!!! I don't know, I guess I just fed too much, even though it's not a lot. Should I have treated it like when feeding high carb gravy for hypo, like a tablespoon instead of most of the can? I would've thought he could handle most of a can since it is not supposed to be high carb. Or should I take some of these foods back that have these bad ingredients, regardless of what the chart says?

Note that I increased his dose last night, and I put about 1/3 of a can of this Nulo food in his dinner. He was steady in the 300s all night, you can see. Is that an indicator of anything? Maybe even 1/3 can is too much, and I can put just a tiny bit of higher LC food into his regular LC pate, and it would do the job of stopping a hard drop? Maybe it just doesn't take much at all. Trying to think of a strategy!

Clearly 0.75U is getting better results than 0.5U, but figuring out the food is overwhelming me.

Please help me. I feel lost. Thank you.

 

I see your notes in the spreadsheet. I was thinking too that the snack at +4 made him go a little too high. It kind of cut off the blues a little sooner than we would have liked. But don’t worry, a lot of this feeding business is trial and error. Each cat is different in the way that they respond to carbs. You will soon know when to feed and what to feed. I would have fed just regular low carb food at that 176 because it is not a low blue and it did take him several hours to get there (it wasn’t a really steep drop). A lot of the time just regular low carb food for a snack (a teaspoon or so) will keep their numbers steady. You want to increase the carbs if (1) they have dropped really fast - like maybe 100 points in an hour for example or (2) they are nearing reduction point.

 

And now he’s bouncing from the blue that he’s not used to. But that’s just what happens and not your doing. At least you know that he can get into better numbers. Are you testing for ketones at home? I used a blood ketone meter to check ketones daily after my boy’s DKA. Later when he got into better numbers, I didn’t need to test daily.

 

You only need to feed a small amount for snacks (unless you are trying to get Loki to gain weight.). But remember when you are in a situation where his BG drops low and you need to bring it up that you feed small amounts so that he will stay hungry enough to keep eating the little snacks. That wasn’t the case today, but I am just mentioning it.

Don’t blame yourself. It looks like his body didn’t take long to try to protect itself and start to bounce. I guarantee you that the 8 percent food didn’t make him go black! You did not cause this.

 

What kind of ingredients? Are you seeing starches or grains in there? I hope not. But it’s good that you are checking. A lot of cat food companies have changed their formulas over the last few years.

 

Now you are getting the right idea. We often recommend doing this - just put a tiny bit of gravy or HC food on top of something else at snack time. With many cats that is enough. But remember that snacks are usually small and are spaced out during the early part of the cycle (before nadir) so as to not shorten the duration of the insulin. A lot of cats just meed a teaspoon of low carb food a few times before nadir to stop them from dropping too quickly.
Like I said: trial and error.

 

Just seconding everything Suzanne said!

 

@Suzanne & Darcy - Thank you for all your advice, you're very sweet! Sorry I am just responding. Please feel free to chime in on my next questions.

@FrostD @Bron and Sheba (GA)

Please, please help...Loki is not making things easy on me lol...Please look at his SS. He has been very high consistently and I don't know why. He is not responding with his usual lower nadirs with the 0.75U dose. In your experience, is it normal for a cat to drop quickly on the dosing scale, only to have to come back up again? I'm assuming I need to increase his dose again? I'm worried the ProZinc is not working for him, or is it I just don't understand yet? I'm very worried. I have been pee testing for ketones, still negative as of yesterday, but will test again today. He does seem to have a slight increase in thirst, and his urine clumps are larger in the litter box. Also, possibly slightly hungrier.

Good news is that I successfully got a blood sample from Loki for my ReliOn meter yesterday!! Twice actually! So I can now learn to use the ketone blood meter as well. Which I was wondering, since he is also using a Libre sensor, do I need to differentiate on his SS if a reading was from the sensor or the ReliOn? And how would I do that if so?

Thank you.

 

It really does look like he needs an increase. All those blacks concern me. I suppose most were taken with the Libre? Tonight will be cycle 12 on the .75 units. If he has ketones, I would consider increasing immediately. He did have just a little bit of higher blue on this dose, but because of all the blacks... and depending upon what you report back to us regarding ketones.... and because he has a Libre and you also can test with the ReliOn and you are so carefully monitoring him... if he were my cat, I would increase the dose as soon as possible. I see you changed food to one with no starches, right? It could be that the tapioca starch was affecting BG. So depending on what I found with regard to ketones, I would make up my mind whether to increase tonight or to wait until tomorrow morning. @FrostD @Bron and Sheba (GA) Melissa and Bron, what do you think?

 

Choosing food is becoming a huge concern of mine, especially since he is not liking Fancy Feast anymore. Do I focus more on a food calculating as a low carb food? Or on the ingredients? For instance, Sheba Perfect Portions pate's calculate as a low carb food, however, it contains tapioca starch. This is what I have been feeding Loki, and I'm concerned that tapioca starch is causing his spikes.

Or there are other foods listed on the food chart as "low-carb" range (around <4%) or the higher low-carb range (around 7-9%) and when I went shopping, some of the ingredients in these supposedly low-carb foods contained rice, wheat gluten, carrageenan, etc. I can't remember them all, but things of that nature, and enough to confuse the heck out of me.

 

Yes, all readings except two (which I marked) were taken from the Libre. I'm not sure how to differentiate the readings from each other on the SS other than to mark it. I will definitely be increasing his dose, and based on what the others say, I should increase to 1U, correct?
Yes, I am trying a new food out with ingredients that look fine. I just responded to you about my food concerns. I definitely think the tapioca starch in the Sheba was not doing any good, even though this food is technically a "low carb" food.

Also, what do I do if there are ketones present?? I've never asked this.

 

With ketones, you want to increase their water intake. You can add extra water to their food... if you aren't already doing this. Make sure they keep eating a healthy amount of food. You also will probably have to increase insulin more often than the SLGS schedule typically would permit. I used to give my boy sub-q fluids when his ketones were high, but adding water to food will help. Of course, it depends on how high the ketones are. My cat had high ketones for a long time and did not have a recurrence of DKA. The original DKA was brought on by an infection. When he was hospitalized, he had a fever over 105 degrees. So as long as he keeps eating enough food and drinking water/having water added to food and does not seem lethargic, you should be okay. It warrants a lot of kitty observation. You can drive yourself crazy with testing ketones though. They do fluctuate throughout the day. I usually tried to test only once per day or twice at most (and those strips are expensive! but much less expensive than an emergency hospitalization.)

 

As for marking the ReliOn readings versus the Libre. I've seen people do different things. Some people will use an asterisk to show that it's a ReliOn reading (if the majority of numbers in the SS are Libre readings.) I would just be sure to check with the ReliOn if you get an unusually low number or any number that just doesn't seem right to you.)

 

Also, I had a column on my spreadsheet at the end before the Notes/Remarks to record the NovaMax ketone numbers.

 

Have you tried any of these foods?
https://www.bizave.com/foodlists/Combined_Food_Lists_Feeding_Guide.pdf

 

Click on the diabetic cat list of foods above. That list is very extensive and is designed for cats with CKD. But the one list is low carb and low to moderate phosphorus (which is good for all of our adult cats because it's easier on the kidneys.) I understand about food driving you crazy. I have spend hours and hours pouring over food lists.

 

Let's see what everybody thinks, but I think probably one unit, yes. But you can wait six cycles and see where he is then and keep checking ketones daily. Is he eating well now? Since he has a history of DKA, I would not hold the doses too long unless the numbers warrant it.

Also, I would avoid things like tapioca starch, wheat gluten, rice, and I don't feed carageenan anyway even though it's not a starch. Currently, I am feeding mostly Weruva BFF PLAY pates (Chicken, Duck and Turkey Take a Chance and Chicken and Lamb Laugh Out Loud.) But some cats won't eat pates. They are very moist, so pretty hydrating.

 

So even if he is bouncing a little from his brief foray into lower numbers (the blues) I still think that it's safe to do the increase now because he is just so darn high. I'll check back in later tonight to see what happened Best wishes!

 

I'm so sorry your kitty went through all of that <3
I always add additional water to his food, so I'm doing that. He has been drinking a little more water from his bowl too, although I'm not sure if increased thirst is a good thing, or is helping, or is just a result of his high BGs? I've been feeding him when he wants to eat, but obviously needs to eat food that doesn't spike his BG, so I hope I'm on the right track with that. @Bron and Sheba (GA) has been trying to help me with keeping his insulin higher while finding a balance of food with maybe a little higher carbs to help him keep the dose higher. That's where you came in on this thread a few days ago.
Loki does not seem lethargic, he's been playful and loving, so that's good.
And: I was able to blood test for ketones this afternoon! Result: 0.5! Loki was so good and patient with me this afternoon, and just let me do it! And yes, the strips are expensive but beats that hospital bill for sure!

This is a good idea, I can add that when I get a chance! I also use the NovaMax And I'll take a look at the list of foods you sent, thank you!!

If I don't hear from anyone by the time dosing time comes (an hour from now), I will give 1U, because he definitely needs an increase. I'm sure I will hear something soon after. I will keep checking ketones for sure! And yes, he is eating well these days, and does like pate's. I will look into those Weruva foods you're feeding too.

Thank you for being here and for planning to check back!

 

Glad on the ketones!

Yes, 1U

 

I am happy his ketones were only.5. Now let’s hope his BG will first of all get out of the black.

 

Thanks, I gave 1U!
Do you have an idea of why this is happening? @Suzanne & Darcy and I were wondering if it’s from tapioca starch in the food. Or is it just a normal part of Loki being unregulated and his body trying to adjust, combined with trial and error? Is it possible the ProZinc can stop having the proper effect? I’m just stunned how high his numbers have remained. I’m hoping @Bron and Sheba (GA) can comment about some of this too later on

 

I think you just have a very bouncy kitty, very unused to numbers that are even close to normal. I also have my suspicions about post DKA cats and how they are treated in hospital, in terms of they are slammed with all irts of insulin, then if that was too much they get the IV sugar to come back up, etc. And while it gets them out of the immediate DKA danger zone, I do wonder about the overall effect, just throwing the body all out of whack. Purely speculation based on what I've seen over time.

I don't think it's the ingredients so much, no. Not unless he's potentially allergic

 

Different cats respond to different proteins and ingredients differently. I know of some cats who usually run higher BGs after eating beef, for example. It may be the tapioca pr may not have anything to do with it.

Wow. I see you got some green today. Not unsafe greens but safe greens. Technically under SLGS that earns a reduction back down to the previous dose - unless you want to switch methods. That was short lived. You will probably see another bounce after today’s greens. What do you think?

 

Any ketones?

 

Hi! I started a new thread for that today if you want to check that out:

https://felinediabetes.com/FDMB/thr...5-73-on-relion-5-5-113-on-relion-6-25.273285/

With everything to learn, I’m still not familiar with the other ProZinc methods..I know there is Tight Regulation and another one that starts with an “M” for ProZinc. I’m just not sure.. but I didn’t hear back advice about dosing in time, so I decided to reduce back to 0.75 to be safe. I can always increase again, but you can never decrease once it’s injected you know.

Have not checked for ketones today, but I need to, thanks for reminding me!