? Vet suggested a dose increase but it seems like a lot

[Charlie'sMom22]

Hello friends!

I've been in contact with my vet regarding Charlie's constipation and recent diabetes diagnosis. I'm currently in the process of switching him from Instinct Original Grain Free Salmon (9% carbs) to the chicken protein (7% carbs). I'm hoping it will help alleviate some of his constipation since chicken is the protein he was eating for his entire life before this.

I emailed the vet to let them know about the diet switch along with his spreadsheet, since he was recently diagnosed and the vet didn't know I was testing at home. After looking at the numbers, she suggested I increase his dose from 2u BID to 3u BID. I agree with an increase as I was thinking he needed it myself, but a whole unit seems high to me. Especially because I'm switching him to a food with slightly lower carbs and his nadirs seem to be mostly below 300. Wondering what you all think?

I haven't chosen a protocol yet because I was waiting to see what the vet said--originally they said to bring him in after 2 weeks since his DX on 2/15, but now she's saying I can increase the dose now and bring him in to have the Libre put on once he's been on that new dose for 7 days. It seems like she's following some sort of protocol that I don't know about. She also recommended that I switch to the AlphaTrak instead of a human meter, which I will not be doing. I've been pretty much on my own with all of this since his diagnosis (aside from you wonderful people ) so I already have a bitter taste in my mouth as far as her advice goes. Plus those strips are ridiculously expensive. And isn't the Libre a human monitor anyway?

In any case, I'm hoping you all can give some dosing advice if you think I should just increase by .5 or if the full unit is good. He's a big guy - 20lbs Maine Coon, which is what his starting dose was based on. I plan on starting the new dose tomorrow morning so I can keep an eye on him all day. It would also be great to have some help choosing a protocol or if I should just continue following my vet's advice.

 

[CORKY]

Hello friends!

I've been in contact with my vet regarding Charlie's constipation and recent diabetes diagnosis. I'm currently in the process of switching him from Instinct Original Grain Free Salmon (9% carbs) to the chicken protein (7% carbs). I'm hoping it will help alleviate some of his constipation since chicken is the protein he was eating for his entire life before this.

I emailed the vet to let them know about the diet switch along with his spreadsheet, since he was recently diagnosed and the vet didn't know I was testing at home. After looking at the numbers, she suggested I increase his dose from 2u BID to 3u BID. I agree with an increase as I was thinking he needed it myself, but a whole unit seems high to me. Especially because I'm switching him to a food with slightly lower carbs and his nadirs seem to be mostly below 300. Wondering what you all think?

@Bron and Sheba (GA)
@Diane Tyler's Mom GA

I haven't chosen a protocol yet because I was waiting to see what the vet said--originally they said to bring him in after 2 weeks since his DX on 2/15, but now she's saying I can increase the dose now and bring him in to have the Libre put on once he's been on that new dose for 7 days. It seems like she's following some sort of protocol that I don't know about. She also recommended that I switch to the AlphaTrak instead of a human meter, which I will not be doing. I've been pretty much on my own with all of this since his diagnosis (aside from you wonderful people ) so I already have a bitter taste in my mouth as far as her advice goes. Plus those strips are ridiculously expensive. And isn't the Libre a human monitor anyway?

In any case, I'm hoping you all can give some dosing advice if you think I should just increase by .5 or if the full unit is good. He's a big guy - 20lbs Maine Coon, which is what his starting dose was based on. I plan on starting the new dose tomorrow morning so I can keep an eye on him all day. It would also be great to have some help choosing a protocol or if I should just continue following my vet's advice.

@Bron and Sheba (GA)
@Diane Tyler's Mom GA

 

[Charlie'sMom22]

I was also debating switching him off of Instinct altogether and instead switching him to something super low carb with a bit of fiber, like TikiCat Aloha Friends chicken & pumpkin or the Luau Mousse chicken & egg. It's still early enough in the transition that I can still pick a different food I think (day 2 still at 10% new food). Curious what everyone's thoughts are on TikiCat and fiber. He won't eat psyllium husk.

I also want to note that although I would prefer to wait until he's regulated on insulin to change his food, he's gotten progressively pickier about his current salmon food, and I have to add a buttload of chicken broth and crumbled freeze-dried chicken "powder" to it anyway to even get him to eat it. I need to switch him ASAP.

 

[Sienne and Gabby (GA)]

The Tight Regulation Protocol was published in a leading veterinary journal a number of years ago. It is based on dose adjustments of 0.25u when either increasing or decreasing a dose. The exception would be a dose increase of 0.5u if the cat is experiencing nadirs that are consistently over 300. In Charlie's case, his nadirs have been as low as 159 in the past week. I would be very hesitant to suggest an increase of 1.0u. I would encourage you to increase his dose by 0.25u.

You may want to look at the dosing methods sticky on the Lantus forum.

 

[Charlie'sMom22]

The Tight Regulation Protocol was published in a leading veterinary journal a number of years ago. It is based on dose adjustments of 0.25u when either increasing or decreasing a dose. The exception would be a dose increase of 0.5u if the cat is experiencing nadirs that are consistently over 300. In Charlie's case, his nadirs have been as low as 159 in the past week. I would be very hesitant to suggest an increase of 1.0u. I would encourage you to increase his dose by 0.25u.

You may want to look at the dosing methods sticky on the Lantus forum.

Thank you for validating me, I thought that seemed like an unreasonably high increase, haha.

As I've been reading about the two protocols, I've been leaning more toward TR since our lifestyle already meets the criteria (small meals throughout the day, I WFH so can test often, LC wet food, etc). However, the reason I'm hesitant to choose TR is I'm extremely nervous about shooting low and hypo events with a lack of an ER vet. I live on an island and the closest emergency vet is almost an hour away, and the vets that are on the island are only open during weekdays. I also don't have a car. Would it be possible to do the TR protocol but with a higher no-shoot threshold, similar to SLGS?

 

[Wendy&Neko]

Would it be possible to do the TR protocol but with a higher no-shoot threshold, similar to SLGS?

We don't mix and match the dosing methods. Each dosing method has tested safety mechanisms built in for people using that particular dosing method. However, what you could do is start with SLGS, build data on how Charlie uses the insulin and when you are more comfortable, switch to TR. You don't have to pick one dosing method and stick with it forever.

I'm extremely nervous about shooting low and hypo events with a lack of an ER vet.

Neko's first low event (below 50 on a human meter), she started the day at around 430. Same high number preshots with the next several reductions earned. With Lantus, lower preshots tend to give much flatter cycles. We also suggest that people take their time to build data and thus confidence with shooting lower numbers. Even with SLGS, once you have data, the no shoot level is 90. But you get there over time. Same with TR.

One should always be nervous about hypos. Over time, you will build the knowledge about how Charlie uses insulin, and what sort of carbs it takes to raise his numbers to a safe range.

Which leads into the question of what carbs to feed. Some cats do better with slightly higher carbs - every cat is different (ECID). Most people here feed food in the 3-6% carbs range. I fed 4 different proteins in rotation.

 

[Sienne and Gabby (GA)]

In addition to what Wendy noted, my cat was notorious for dropping into low numbers very quickly. She never experienced symptomatic hypoglycemia in part because I tested a lot especially during the early part of the cycle because Gabby had an early nadir. If you look at her spreadsheet you'll see what I mean. Building up your knowledge about how your cat responds to insulin as well as your confidence about how to intervene if your cat drops into low numbers is important. Home testing is a huge factor in guiding you. In addition, there's a difference between low numbers and symptomatic hypoglycemia.

 

[Charlie'sMom22]

We don't mix and match the dosing methods. Each dosing method has tested safety mechanisms built in for people using that particular dosing method. However, what you could do is start with SLGS, build data on how Charlie uses the insulin and when you are more comfortable, switch to TR. You don't have to pick one dosing method and stick with it forever.


Neko's first low event (below 50 on a human meter), she started the day at around 430. Same high number preshots with the next several reductions earned. With Lantus, lower preshots tend to give much flatter cycles. We also suggest that people take their time to build data and thus confidence with shooting lower numbers. Even with SLGS, once you have data, the no shoot level is 90. But you get there over time. Same with TR.

One should always be nervous about hypos. Over time, you will build the knowledge about how Charlie uses insulin, and what sort of carbs it takes to raise his numbers to a safe range.

Which leads into the question of what carbs to feed. Some cats do better with slightly higher carbs - every cat is different (ECID). Most people here feed food in the 3-6% carbs range. I fed 4 different proteins in rotation.

Ah, thank you!! For some reason I thought it wasn't possible to change dosing method. I'm going to do just as you suggested and start with SLGS until I have more data and am more comfortable.

I have a hunch that Charlie would do better on lower carbs. He ate a raw diet for 12 years, up until a couple months ago. According to Dr. Pierson's chart that food was 3% carbs. His current food is 9%. If I switch to something closer to 3%, will that affect his numbers? And if so, how quickly? Just curious what I should look out for, if anything.

 

[Diane Tyler's Mom GA]

Previous post for continuity
https://felinediabetes.com/FDMB/thr...-threshold-is-for-lantus.298469/#post-3247239

 

[Charlie'sMom22]

In addition to what Wendy noted, my cat was notorious for dropping into low numbers very quickly. She never experienced symptomatic hypoglycemia in part because I tested a lot especially during the early part of the cycle because Gabby had an early nadir. If you look at her spreadsheet you'll see what I mean. Building up your knowledge about how your cat responds to insulin as well as your confidence about how to intervene if your cat drops into low numbers is important. Home testing is a huge factor in guiding you. In addition, there's a difference between low numbers and symptomatic hypoglycemia.

Thank you, that's good to know. I took a look at Gabby's spreadsheet and I see what you're talking about. Is it possible for a cat to have a different pattern in their PM cycle? Charlie's seems weird, but I don't have enough data to pinpoint it yet. I may try to do a curve this weekend or just wait until the Libre is placed to get more PM numbers.

 

[Charlie'sMom22]

Previous post for continuity
https://felinediabetes.com/FDMB/thr...-threshold-is-for-lantus.298469/#post-3247239

Thank you Diane! I'm so sorry--should I be linking my previous posts whenever I make a new one?

 

[Diane Tyler's Mom GA]

@Charlie'sMom22
Hi Jess no need to be sorry I think you can start posting on the Lantus Forum every day
You would put in your title the
Date Charlie AMPS # and any other additional tests after that and you can continue with his PMPS also and any additional tests after that.

To add the tests look to the right and tap on where it says Thread Tools then tap on Edit Title and add the additional tests then tap save or done

We prefer you to post everyday if possible and then link your previous days post to your new one in case a member needs to go back and read something.
You're doing a great job with Charlie
When you decide on the dosing method just add it to your signature and spreadsheet up top

Just in case here is how to link your previous days post


To link your previous posts
Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be
Just ignore where it says insert and cancel
Just copy your previous days post and then paste it when you do your new post new thread





Like I said
your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it, only way I can explain it

 

[Wendy&Neko]

He ate a raw diet for 12 years, up until a couple months ago.

Any particular reason you stopped feeding the raw? We have a number of people here feeding raw diets - I was one of them.

Is it possible for a cat to have a different pattern in their PM cycle? Charlie's seems weird, but I don't have enough data to pinpoint it yet.

Absolutely! Many cats go lower at night. Which is why we suggest getting a before bed test, so you can see if there is a big drop happening at night.

 

[Charlie'sMom22]

@Charlie'sMom22
Hi Jess no need to be sorry I think you can start posting on the Lantus Forum every day
You would put in your title the
Date Charlie AMPS # and any other additional tests after that and you can continue with his PMPS also and any additional tests after that.

To add the tests look to the right and tap on where it says Thread Tools then tap on Edit Title and add the additional tests then tap save or done

We prefer you to post everyday if possible and then link your previous days post to your new one in case a member needs to go back and read something.
You're doing a great job with Charlie
When you decide on the dosing method just add it to your signature and spreadsheet up top

Just in case here is how to link your previous days post


To link your previous posts
Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be
Just ignore where it says insert and cancel
Just copy your previous days post and then paste it when you do your new post new thread





Like I said
your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it, only way I can explain it

Okay thank you! I’ll start a post there tomorrow and follow the instructions you gave. I’ll let you know if I have any trouble.

 

[Charlie'sMom22]

Any particular reason you stopped feeding the raw? We have a number of people here feeding raw diets - I was one of them.

Absolutely! Many cats go lower at night. Which is why we suggest getting a before bed test, so you can see if there is a big drop happening at night.

Yes, I stopped feeding raw because I’m worried about bird flu, especially because he was on the chicken one. There have been a handful of recalls of raw food contaminated with it. I’m wary of all raw food right now.

 

[squeem3]

Would your cat eat a different protein such as rabbit or beef? Some people make their own raw food from scratch or with a pre-mix and aren't concerned about bird flu.

 

[Charlie'sMom22]

Would your cat eat a different protein such as rabbit or beef? Some people make their own raw food from scratch or with a pre-mix and aren't concerned about bird flu.

I doubt it. This whole process has made me realize how picky he is, probably because he just ate straight raw chicken for 12 years and never knew anything else lol. I'm really not comfortable feeding any raw at the moment. I think the bird flu situation is going to get worse especially with all the cuts and comms blackouts.

I have a plan to try this switch to chicken and see if it helps at all. If that doesn't work I may try a different brand like TikiCat. And if that doesn't work then I will either go back to raw with a different protein or gently cook chicken and use a pre-mix. I'll cross that bridge when I come to it.