? 4/1 Millie, Post DKA, PMPS 253, +4 189, +7 285, AMPS 686 (AT) Lantus. Still don't know why the bounc

[Sylvia & Millie]

Relatively new at this and just when I think I get it, I'm lost again! Millie is post DKA, on Lantus. Whenever we have increased she seems to have worse 'bouncing'.

We had put her on Wellness CORE food to help her increase her weight after two bouts of DKA. One thread explained that with her post DKA it was more important to get her in better health (eating, weight) and it made absolute sense. I don't know if the food is contributing to the up & down readings or if she just continues to bounce because of not having the right dose? We got some night tests done and I thought she was fine until we tested this morning.

I feel like we're all over in her dosing as well. I want to lower to the 1 unit again but I don't want to make things worse. We are doing SLGS but I might be switching to the TR.

Also, I'm not sure what I'm aiming for in her numbers anyway?!



http://www.felinediabetes.com/FDMB/...t-lantus-is-she-bouncing.175624/#post-1930132

 

[Sienne and Gabby (GA)]

Welcome, Sylvia!!

You might want to check on Dr. Lisa's food chart regarding the carb level of some of the Wellness Core varieties. They range from 5 to 18% carb. If you're feeding the higher carb flavors, that would contribute to higher numbers.

I know the bouncing is frustrating and crazy making. However, it's pretty normal -- annoying, but normal. Cats tend to bounce until they don't. Since Millie is still new to FD, I wouldn't get overly concerned. If this persists over time, there may be some strategies that will help but it's a bit soon to get concerned. Bouncing isn't a result of an incorrect dose. Bounces result from numbers dropping low (e.g., below 50), numbers dropping into a range that's lower than what your cat is used to, or a fast drop (e.g., when Millie dropped about 200 points from PMPS to +3 on 3/29). When the numbers do this, the liver and pancreas release a stored form of glucose along with counterregulatory hormones which act to cause BG to spike upward.

I'd encourage you to keep up with getting PM tests. This will give you greater insight into whether the numbers are bouncing around. It's particularly important to get PM tests if you are gone during the day. If you are home during the day, getting spot checks is important. Lantus dosing is based on the lowest numbers in a cycle, not on the pre-shot so trying to catch numbers that are around nadir lets you know whether to decrease (or increase) the dose.

I also wouldn't worry about the amount of insulin you're giving, especially with a kitty that's post-DKA. With a cat that's prone to ketones, it's important to maximize the insulin (ketones = infection/inflammation + not enough calories + not enough insulin). Aside from DKA, the numbers will dictate how much insulin your cat needs. Getting overly focused on the amount of the dose doesn't help your cat. The cat's body needs what the cat's body needs.

As for as what you're aiming for, if your goal is remission, you want Millie to be spending as much time as possible in normal numbers (i.e., 50 - 120 on a human meter) and even better, if she's in "green" numbers. If your goal is regulation, you want to try to keep her under renal threshold (around 200 on a human meter).

 

[Sylvia & Millie]

Welcome, Sylvia!!

You might want to check on Dr. Lisa's food chart regarding the carb level of some of the Wellness Core varieties. They range from 5 to 18% carb. If you're feeding the higher carb flavors, that would contribute to higher numbers.

The Well CORE variety is beef, venison & lamb (13% c). She's put on a little weight which is nice to see because she was skin & bones after her hospitalization. She can still put on a pound or so and be far from overweight. We will be buying an auto feeder to assist with timely meals.

I know the bouncing is frustrating and crazy making. However, it's pretty normal -- annoying, but normal. Cats tend to bounce until they don't. Since Millie is still new to FD, I wouldn't get overly concerned. If this persists over time, there may be some strategies that will help but it's a bit soon to get concerned. Bouncing isn't a result of an incorrect dose. Bounces result from numbers dropping low (e.g., below 50), numbers dropping into a range that's lower than what your cat is used to, or a fast drop (e.g., when Millie dropped about 200 points from PMPS to +3 on 3/29). When the numbers do this, the liver and pancreas release a stored form of glucose along with counterregulatory hormones which act to cause BG to spike upward.

I was totally under the impression that the numbers drop because of too much insulin, then the body compensates. I've been so focused on trying to even out her numbers. I am going to stick to the 1 unit for now until we gather more info via tests. We'll do more tonight.

I'd encourage you to keep up with getting PM tests. This will give you greater insight into whether the numbers are bouncing around. It's particularly important to get PM tests if you are gone during the day. If you are home during the day, getting spot checks is important. Lantus dosing is based on the lowest numbers in a cycle, not on the pre-shot so trying to catch numbers that are around nadir lets you know whether to decrease (or increase) the dose.

I also wouldn't worry about the amount of insulin you're giving, especially with a kitty that's post-DKA. With a cat that's prone to ketones, it's important to maximize the insulin (ketones = infection/inflammation + not enough calories + not enough insulin). Aside from DKA, the numbers will dictate how much insulin your cat needs. Getting overly focused on the amount of the dose doesn't help your cat. The cat's body needs what the cat's body needs.

As for as what you're aiming for, if your goal is remission, you want Millie to be spending as much time as possible in normal numbers (i.e., 50 - 120 on a human meter) and even better, if she's in "green" numbers. If your goal is regulation, you want to try to keep her under renal threshold (around 200 on a human meter).

We use the AT so I'll check what the equivalent would be.

It might be my age, current medical issues/meds, but sometimes I'm quite challenged maintaining my understanding of all this, lol!! Very early on someone told me to have patient, I need to repeat the to myself.

Thank you though for the feedback.

 

[DebG]

Sylvia it will take time and patience to get the right magical dose. There is quite a bit that plays into this FD. Food, their health and meds can raise and some lower the BG's. You will get there

 

[Sienne and Gabby (GA)]

Please don't confuse the percent of carbohydrates with calories. Especially with a kitty that's been through DKA, you need to concentrate on how many calories Millie's getting. The carbs raise her BG numbers. Carbs and calories are not necessarily correlated. You will want to select food that is less than 10% carbs in order to be feeding your kitty a low carb diet. If you want ti stick with Wellness, the "Complete Health" flavors are almost all low carb and high in calories.

Numbers certainly can drop if there's too much insulin. This is why you want to stick with a dosing method. Both SLGS and TR will guide you as to when you need to reduce the dose. You want to increase and decrease doses systematically. I do, however, want to underscore that we tend to treat DKA kitties differently. If Millie is prone to developing ketones, I would encourage you to maximize the amount of insulin and intervene with food to keep her numbers from dropping. Until you think she is over the hurdle of DKA, you want to be getting as many calories and as much insulin into her as possible to prevent the ketones from redeveloping.

Following SLGS is fine as long as you continue to see no ketones. If you're not already doing so, think about adding water to Millie's food. The extra water will help to flush any ketones from her system and it's good for her kidneys.

I wouldn't necessarily attribute not understanding all of this information to anything other than learning all of this is completely overwhelming at first. You've been managing Millie's FD since January. The front end of this learning curve is huge.

 

[Sylvia & Millie]

We just bought her 12 cans of the Wellness CORE but we'll return it; thanks for recommending the other Wellness food. We are adding water to her food.

I am trying to figure out when best to maximize the dose but I'm learning it's not a black and white decision. Her +5 BG was 610! Then her +7 BG was 487. These are the numbers after lowering the insulin dose. I just ordered a feeder and will change her food to see if that helps.

Your post was comforting. I try to remind myself that I felt this way when my other kitty got his CKD and when our dog was diagnosed with a neurological condition. In time I figured it out and they are both doing pretty well. Now it's Millie's turn.....

 

[Sylvia & Millie]

Please don't confuse the percent of carbohydrates with calories. Especially with a kitty that's been through DKA, you need to concentrate on how many calories Millie's getting. The carbs raise her BG numbers. Carbs and calories are not necessarily correlated. You will want to select food that is less than 10% carbs in order to be feeding your kitty a low carb diet. If you want ti stick with Wellness, the "Complete Health" flavors are almost all low carb and high in calories.

Numbers certainly can drop if there's too much insulin. This is why you want to stick with a dosing method. Both SLGS and TR will guide you as to when you need to reduce the dose. You want to increase and decrease doses systematically. I do, however, want to underscore that we tend to treat DKA kitties differently. If Millie is prone to developing ketones, I would encourage you to maximize the amount of insulin and intervene with food to keep her numbers from dropping. Until you think she is over the hurdle of DKA, you want to be getting as many calories and as much insulin into her as possible to prevent the ketones from redeveloping.

Following SLGS is fine as long as you continue to see no ketones. If you're not already doing so, think about adding water to Millie's food. The extra water will help to flush any ketones from her system and it's good for her kidneys.

I wouldn't necessarily attribute not understanding all of this information to anything other than learning all of this is completely overwhelming at first. You've been managing Millie's FD since January. The front end of this learning curve is huge.

Just checked and the CORE is 5-13% carbs with cal from 182-210. The Healthy Indulgence is 14-19% carbs and it's low in calories (57-62 for 3oz pouch). I think I'll continue with the Core since it's higher in calories; I'll give her the chicken at 8% carbs.

Thanks!

 

[Sienne and Gabby (GA)]

Her +5 BG was 610! Then her +7 BG was 487.

That's a huge drop in 2 hours. If it were me, whenever I would see a large drop like you just noted or if the numbers seemed to be way too high or way too low, I would re-test immediately Sometimes you can have a bad strip or a bad test.