Hi Tanya
Thanks for your patience. First, I’d like to address what we were discussing yesterday and then give you my thoughts on her dose.
While the early morning urine might look more concentrated, it still might not be as concentrated as it should be. You can buy a handheld refractometer through Amazon and check it at home. This is what I did with Gracie. They aren’t expensive and it makes it a little easier. I hope the SDMA won’t take too much longer. Crazy.
You fixed her SS! Good job. If, in the future, you want to allow me editing rights if there is an issue, just PM me as I’ll have to give you my email address. It won’t recognize “Marje and Gracie”.
It would have been really nice if your vet would have run the full GI Panel when they did the TLI and PLI. It just makes more sense to do so. The MCV can be elevated in cats or humans if there is a lack of absorption of food in the intestines. That’s why giving humans B12 injections (and cats) can help with intestinal absorption. But we don’t know if that is the cause of her elevated MCV. Oral methylB12 helps with anemia but it does nothing for intestinal absorption in cats. That has to be injectable cyanocobalamin. Unless you have a full GI Panel done which tells you she has low folate or unless she is having very clear symptoms of IBD or intestinal issues, it would be another, possibly unnecessary, shot for her and the needles are bigger.
I’m very glad to see she has had some green numbers on the 1.25u dose. She’s also started clearing her bounces a little faster. Keep in mind that when you shot the reduced dose of 0.5u p.m. cycle of 10/29, she needed some time to adjust the depot. That’s a sizable reduction from 1.5u. And she was also bouncing from the time spent in lower numbers that day. I think the fact that she was back in blue within three cycles....even though it was just a tiptoe, is a good sign.
With all the SSs I’ve looked at and the time on the board I’ve spent, I rarely see a 0% carb cat food work unless the cat is extremely carb sensitive. We have had some of those but, for a lot of the cats, they do much better if you are feeding foods that are 6-10% carbs. Remember that the insulin you are shooting is taking the blood glucose out of the blood and helping it get into the cells. If there are no carbs to help “offset” that insulin or for the insulin to work on, then the BG drops and sometimes it dives. It’s the same thing if you give insulin and then the cat doesn’t eat; the insulin is still there waiting to do the job but there’s no food generating carbs for it to work on. I did the same thing as most members starting out by feeding 0-2% carb foods. Big mistake. I found that what really worked for Gracie was to feed 5-10% carbs.
I saw you are partially baking the raw with EZ Complete. Great premix....I use it as well
It’s fairly low carb, though, so it’s not going to be as good for controlling numbers and I see you’ve had to give her MC and HC gravy at times to control numbers.
My question for you is do you know what her onset, nadir, and duration are? It will help in managing her curve if you know what they are. They might be different from a.m. to p.m. cycles. They also might change some. It’s important to figure her nadir out without any MC or HC food involved and you also have to test a bit more to find it.
The goal is to keep her as flat as you can and you can use carbs to do that. I see that you vary her feeding schedule. Sometimes you feed at AMPS, +1, +2 but this is not consistent and that’s where we need to focus. You want to consistently feed her at specific times each a.m. cycle and, if her cycles are the same, also at the p.m. cycles. Overall, she seems, to me, to go a little lower on the p.m. cycles. I also don’t understand why she is fed at +7 routinely. I can understand it if she is still dropping but, normally, it’s not a good idea to feed after nadir as you put the brakes on duration. I do understand you give her a snack at +9 so she doesn’t vomit. Yesterday at +9, you fed her 6% and raw and that seems a bit much to me without knowing what her BG was and if she needed that. I like to suggest just freeze dried treats or boiled chicken at +9 if kitty needs it to prevent tummy acid. Of course, the caveat is that if she’s really dropping towards 50 at that point, you’ll need more carbs but if she’s flat or if she’s not in danger of dropping low, I’d try to stick to a snack rather than a minimeal and I’d keep it really LC.
Rather than reinvent the wheel, I’d like to repost information I just gave Darrah for Girlie. Ducia is not diving as often as Girlie but she did take a few deep drops last week when she got into black. Remember...the higher they are, the faster they can drop so we want to even it all out.
The goal is:
manage the curve with food ----> flatten the curve ------> adjust the dose (if necessary and it usually is).
This process or method is feeding so that we prevent the kitty from dropping too fast and/or too low. You can imagine if you aren’t careful with it, you can overfeed the kitty so it’s important to:
- recognize this is a process that doesn’t change things overnight
- requires that you, in general, feed the same amount of food kitty needs to maintain its current weight (assuming kitty is not under or overweight); obviously, if you’ve fed Girlie her food for the cycle and then she fools you and takes another dive, you might have to feed a little more depending on where in the cycle she drops again.
- requires consistency and some extra commitment at the beginning
- requires that you know your kitty; what are her onset, nadir, duration......and does she ever get any overlap or carryover.
Typically, unless the kitty is taking a huge dive or drops below 50, we try to use LC to manage the curve with food. Obviously, if she is coming down really fast early in the cycle and we know LC doesn’t slow her down, you have to up the “ante” (i.e. the carbs). However, we do not typically feed a higher carb food
at shot time unless you must have the insulin start its onset from a higher number, for example, in the case where you might not be able to monitor.
There are important things to consider when you are determining whether to feed lc, mc, hc:
- where is she in the cycle? If it’s early in the cycle and she’s dropping fast, you probably want to use higher carb food; if it’s nadir or later in the cycle and nadir is above 40, you might want to try LC.
- how carb sensitive is she? Some kitties never need more than LC food even when they take a steep dive or go lower. Others need the big guns if they drop fast early in the cycle. This is going to be up to you to figure out and experiment with. We want to feed to be proactive and not reactive but feeding reactively is what we all do at first.
It’s also important to know why we manage the curve with food. The goal is to get the curve to flatten, as shown in the diagram above. If we are consistent and do it right (and it’s ECID and trial and error as to what is “right”), then kitties will typically flatten out at a higher BG. Flattening prevents those dreaded dives and huge bounces. Flattening also will allow you to get more insulin in the kitty
safely. This can, in turn, allow you to hold a specific dose longer. In addition, lantus and levemir are not insulins that can pull high numbers down as quickly as some of the other insulins can. However, for a bouncy cat, more insulin can help bring down the numbers. It also helps to offset the spikes that very carb sensitive kitties get in response to food.
For anyone reading this who then thinks, “well, if I just give my cat more insulin, the bouncing will stop”.
No it won’t and it’s not safe to just increase the dose to stop bouncing. It’s the process of managing the curve with food
specific to your cat that keeps it safe to increase the dose. That entails:
- knowing your cat and having the time and commitment to experiment with feeding
- feeding the correct amounts of food at specific times to bring the over all curve up
- flattening the curve at a higher BG
How do we do this for a cat on lantus?
- start by dividing the kitty’s normal food portion into four minimeals each cycle which are fed consistently at PS, +1, +2, +3, at first.. As you get more data, you might need to adjust those feeding times especially if your kitty onsets later and you might find you have to feed at different times to address the difference in cycles.
- determine if kitty needs to be fed the same amount at each meal or if he/she needs to be fed different amounts at each meal. As an example, I studied Gracie’s SS when she was on lantus and figured out when she onset and when she took her steepest dive. I then determined I really needed to “frontload" her cycle with food. This had me fine tuning not just the times I fed her but feeding the majority of her food at PS and +1 and a little less at +2 and +3. Over time as I got more data on how she did with that, I changed the amounts of food and also changed the feeding times. When I switched her to levemir, I had to do the same thing all over again.
- test more at first to catch the drops. And did I say test? When you are first starting manage the curve with food, I would suggest you test every cycle at PS, +1, +2, +3 because that is most likely when the dives will occur. You need to figure out exactly where she drops so you know exactly when and how much to feed to prevent the drop. Don’t get complacent if she’s higher at +1 than PS and think “I’ll test at +3”. This will not be forever. This is just to find out where she drops so you can then manage the curve appropriately to flatten her out. Over time, as you start at a lower and lower PS, the dives should stop and you can get back to regular testing. Now is a good time for you to try it since you have to go back to work full time the end of November.
- realize that even after it works, she might, at some time, revert back to her diving. Gracie did occasionally. I would start testing more to find out where she was dropping and then I could get proactive to adjust feeding the curve to prevent the drop. (Keep in mind, once I started managing the curve with food, I always did but patterns change from time to time and you have to be flexible and realize what worked for one pattern, might need a bit of fine tuning for another).
In summary, learning to manage the curve with food involves learning how Ducia responds to different carbs at different times during the cycle. You have to be a scientist and an investigator. Write
everything down (you’ve actually been doing a really good job but I’d go a little further and note the response you got to what you fed, how much you fed, and when you fed it). What kind of a bump does she get from LC, MC, HC early in the cycle and late in the cycle? Using this info, you can guide the cycles. Again, remember you might find that you have to steer the cycles differently. Gracie had a different a.m. cycle than p.m. and so her feeding schedules were a bit different. Any time you make a change, leave it for 3-4 days and give her time to adjust before you make another change.
Please let me know where you have questions.
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. Not always but often enough to be mentioned here her nadir seemed to be as late as +12. Examples from the recent history are 10/03 PM, 10/07 AM, 10/16 PM, 10/21 AM.
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