9/18/18 Bailey AMPS: 386, Newly diagnosed and confused at +12 nadir

Rosie & Bailey

Rosie & Bailey

Member Since 2018
Hi everyone! My name is Rosie, and my little Bailey was diagnosed in July with a BG of 371 and clinical symptoms of diabetes. (Well, I'm technically her grandma since she is my daughter's baby)

Our vet recommended this board, and I have learned so much already! Thank you all!

Bailey was started on 1/2 unit of Lantus when BG>220, once a day because we were scared to give her insulin at night. Her clinical symptoms disappeared rather quickly, and she has gained a little weight. She was originally on dry food, and she is now on a strictly wet food diet (Crave, but need to switch her to something cheaper).
Recently, our vet was considering having us start dosing her twice a day because of too many high morning readings. I recently attempted a BG curve, and it seems that Bailey hits her nadir at +12. I am still waiting to hear back from our vet as to how she would like for us to proceed with this new information since we were not testing her at night before.

Also, I have been switching around with meters because our vet felt the Prime ReliOn was unreliable to use for decision making after doing a comparison in her office. We got an Alphatrak, but we are trying out the Petsure strips because we simply can't afford the AT strips. The Petsure seem to vary between 10-30 points below the AT numbers. We haven't tried using the AT Turbo code (04) which the Petsure folks claim will bring us closer to the AT numbers. We will probably try that today with our last remaining AT strips.

I recently attempted a BG curve (sort of), and it seems that Bailey hits her nadir at +12. I would love to hear your thoughts on how to help Bailey.

Thank you all for taking the time to help newbies like us!
Rosie
 
Welcome. Where in Pa? I'm in Scranton area.

It might be worth trying .25 units so you can give twice a day. It could help keep ing the morning test from being so high. Fancy Feast pate or friskie pate are good options for food. Since you've changed some already it might just be all you need soon to be diet controlled.
 
Hi Paula. I'm in Stroudsburg, PA. Used to go to Scranton all the time when my kids went to Marywood University's awesome violin program.

I was also wondering about the .25 units. I was hoping to hear back from the vet before changing her dose, but still no response.
I was also reading that some people feed their cats in the middle of the night to keep the numbers from going so high in the morning so I was thinking of giving that a try at some point as well.

Do you feel that the Fancy Feast pate and the Friskies pate are both the same in terms of their effect on BG?
 
RosiePA said:
I was also reading that some people feed their cats in the middle of the night to keep the numbers from going so high in the morning so I was thinking of giving that a try at some point as well.
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I have found by trial and error that this sometimes helps my kitty, Pretty Girl. Even though she has food available, if I actually feed her at about 11:30 pm or so - so +5.5 - it seems to make a difference. Still trying it to see if it works.
 
Some cats do nadir late in the cycle. We had one kitty here that +11/+12 was the lowest part of his cycle. It can happen.

Food can kick start the pancreas to do their job...so well timed snacks can help keep the numbers lower overall.
 
Hello and welcome. I second the suggestion to go to 0.25 units. 0.5 units got Bailey to the 40's on the 5th, so that means it's too much insulin.

As for late nadir cats, my girl was one of them. But I think what is happening here is that you are getting really good duration and too much duration can be another sign the dose is a little high.

As for feeding, if you are giving shots both AM and PM, it helps to be on similar feedings AM and PM as well. Many people get an automated feeder such as the Petsafe 5, so they don't have to get up in the middle of the night to feed, or to feed meals during the day if they are away from the house.
 
Thank you all for your help!

I would like to try to do both, start her on .25 twice a day and try the overnight feedings. What do you all use for a cutoff for the nighttime dosage? My vet had set a cutoff of BG>220 for giving her the once daily dose.

Also, does it matter if I start with the lower does or the overnight feeding, or can I do both at the same time?

The Petsafe 5 looks awesome so I will try to invest in one as soon as I am able. I'm an insomniac so the overnight feeding of wet food won't be much a problem. I had hesitated to feed her at night because I was afraid to throw things off.

I researched Nature's logic which I saw mentioned in JeanW's signature. I will look into that as a nighttime dry food, or maybe look for something similar depending on cost.
 
Welcome! There are amazing people on here, dont know where Bella would without them
When in doubt..ask
 
Thank you, and I agree. This people on the board are amazing, and I hope I will one day be able to offer advice an help others in the future.

I am so thrilled I researched here because, while I love my vet, she was following a standard protocol and recommended 1 unit twice a day for Bailey. It ends up that 1/2 unit was a better way to start, and it seems even that may be too much for her. The day Bailey was diagnosed, I researched the boards where everyone basically made it clear that shooting insulin without testing first is not a good idea so I rushed out and bought my first meter. I really believe that this board saved my Bailey from a potential hypoglycemic episode. I am eternally grateful!
 
RosiePA said:
What do you all use for a cutoff for the nighttime dosage? My vet had set a cutoff of BG>220 for giving her the once daily dose.
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For new people, we suggest not shooting below 200. You will notice that people on this board will shoot lower numbers, but that's as they gain data and experience. With Lantus, when you shoot a lower number, the cycle is typically flatter.

You can start the feeding anytime. I would start the night time dose when you are able to monitor.

For food, any low carb (less than 10% carbs) wet or raw food is fine. This list has quite a few of the ones available in North America. I would stay away from dry food if you can. Besides being better for them, low carb can help their chances of remission, should that be a goal.
 
RosiePA said:
I researched Nature's logic which I saw mentioned in JeanW's signature. I will look into that as a nighttime dry food, or maybe look for something similar depending on cost.
Click to expand...
I think Nature's Logic is one of the very best cat foods available. But I feed only the wet canned food to my diabetic kitty . . and preferably to all my kitties - I have one dry food holdout. I use the wet canned food because it's low carb and because of the high moisture content.

Nature's Logic dry food is high quality but is higher in carbs than most diabetic kitties should have. If I remember right - their dry food is lower in carbs than the average dry food although still relatively high.
 
Vet's office called back, an they are on board with the .25 twice a day. They did suggest a lower cutoff of 180, but I'm kind of nervous with that so I think I will stick with a cutoff of 200. They have asked that I also only feed twice a day with no snacks in between so I guess I will hold off on the overnight feeding unless her sugar gets too low.

We will also continue Fancy Feast or Friskies wet food only. I kind thought the Petsafe was just for dry food, but of course I can put wet food in there.

I will post results tomorrow. Thank you all sooo much!!!
 
Same as for diabetic humans, feeding several small meals is easier on the cat pancreas than two large ones. With the older non depot insulins, feeding just before shot time was common. Your vet or their staff may not be as current on feeding diabetic kitties. Having food out when the insulin is stronger also keep them safer.

Take a look at the food chart to make sure the varieties of food you are feeding are low carb. Pate are the way to go.

Good luck with the new dose
 
That makes so much sense. I think I will contact them again and ask about that. Thanks for the heads up.

I will confirm the foods on the chart before giving them to her.
 
Rosie,

I feed Olive every 3-4 hrs around the clock. That isn't always necessary for most cats. Olive is also a acro cat which means she's just plain hungry all the time.

If you think about it, if you feed when only giving the shot there is no food for the insulin to work with. If I did that Olives blood sugar would drop to low to fast. You can also use food to manipulate the cycle (Olive doesn't cooperate though). You could feed every 6 hrs an not tell your vet until you see how it goes. Some people free feed. The only rule regarding food is no food 2 hrs prior to shot.

I'm about 30 minutes from Marywood.
 
Paula,

What do you mean by acro cat? I looked it up, and I found a circus troupe of domesticated cats which was quite interesting. I couldn't even imagine training Bailey to do those things.

Before Bailey was diagnosed, she ate wet food with gravy and dry food all day, which I think led to her diabetes. Now that she is on low carb wet food diet, she is fine after feeding for a few hours, but several hours before her next feeding, she is begging for food. It makes sense that she is reacting to the low blood sugar so maybe I'll try the every 6 hour diet anyway. I wasn't able to reach the vet, but I think it will really help her and make her a happier cat. I'm also not going to use 180 as a cutoff in deciding to shoot, especially just starting out on the twice daily insulin. I'm 30 minutes away from the nearest emergency vet hospital so I just can't bring myself to risk her BG getting low, especially at night.

I am learning so much here. I didn't realize that fasting meant only two hours. I was applying human rules so I figured she needed 4-8 hours of no food before a shot, especially with my vet explaining that I needed to feed only twice a day.

Could you elaborate what you meant by manipulating the cycle?

Thank you again to everyone here for your help. Your support makes me feel so much better about undertaking this twice a day insulin with Bailey.
 
@RosiePA .

Acro is Acromegaly. Pituitary tumor causing the diabetes. She requires a slightly higher dose of insulin to try to keep her glucose down. There are cats here with much higher doses. My vets here have never dealt with acro. A lot of things I just had to do without them (like changing insulins) increasing doses a lot faster than they like. Once I show them results they are okay with it.

Manipulate with food. Olive can go from 300's to 50 in 3 hrs. So I feed at shot time and +2 and +3 to slow down any potential fast drop. If she pops me a number in the 60's before her 6 hr mark I give her 6% carbs and that sometimes keeps her steady or prevents from dropping to much more.

You will learn all this. Food is an important factor with diabetes. When the tumor is having an active spurt she could eat hourly. To keep her weight controlled I feed by the number of calories she needs and dish it out as needed or she would be way to chunky.

I've learned all this here and still have a lot to learn. Olive is not my first FD kitty. My prior one was diabetic but not acro and he was totally different and had different issues. What works for one might not work for another. You will figure out what works for you and Bailey.

It takes patience and trial and error. Sometimes you lose it and that's normal and we understand. We are here for you when you want to vent, give up, had enough, need a shoulder to cry on. We get it, we really do.
 
Wow, poor Olive. I can't even imagine having a cat that goes from 300 to 50 so quickly, and all the manipulating you have to do throughout the day. The fact that she doesn't cooperate makes it just that more challenging. I think I jinxed myself by saying Bailey was cooperative yesterday. She was not having any of it this morning, even nipped at my daughter when we were giving her the insulin.

I have to learn to not be so reliant on the vet, I know. I am thankful that they are willing to work with me. I've seen some horror stories on here of some pretty difficult vets who insist on a treatment, then refuse to provide guidance if you don't follow the orders exactly. My vet is happy to engage in conversation and accept a compromise when I have a differing opinion.

Thank you all for the suggestion to feed round the clock rather than twice a day. I think it helped Bailey to feed her overnight. She tested PM+6 354. I was worried about feeding her at the time, but then this morning she initially tested AMPS 201. I retested and got 337 and 314 so I don't know which it really is (she was really fighting us too), but they are all lower than the 354 she had just a few hours earlier. We will continue with the every 6 hour feedings because it just makes more sense.


Thank you all so much again!! I will keep you posted.
 
@RosiePA .

Olive cooperates with testing and getting insulin. She doesn't cooperate with using the food to help. She eats well, just some days using the food just doesn't help keep her steady no matter what you do.
 
JeanW,
Yes, I agree! I am very lucky to have them!

Paula,
I misunderstood. Sounds like Olive's health is a real challenge for you. She's lucky to have you in her life.
 
Hi everyone,

So, Bailey has completed her first day under the new schedule, going from .5 units of Lantus once per day to .25 units of Lantus twice per day.
I also started feeding every 6 hours rather than twice a day with snacks at testing.

Here are her numbers for the last two days, which are also in her spreadsheet.
I am using the Alphatrak meter now with PetSure or Alphatrak strips, which seems to run 40-50 points higher than the Prime ReliOn I was using earlier, but even taking that into consideration, her BG levels are higher than I expected.

Could you please share your thoughts? Should I give just slightly above .25 units because maybe she is really between .25 and .5, or does it normally take a few days to see a difference when making this kind of change and I should just stay the course with .25?

Thank you all so much for your support!!


Dose: .5 units Lantus, once per day
AMPS: 386
+9 190
PMPS: 110
+3 141
+6 351

Switched to .25 units Lantus, twice per day
AMPS: 203 (337, 314 right after so maybe faulty strip)
+6 451
+9 351
PMPS: 311
+3 358
+6 324
 
It can take six cycles for the depot to build. Since you've been skipping every other cycle to date, I would stick to 0.25 units as best you can and see if the numbers come down as the depot gets established.
 
Thank you Wendy.
She just tested at 270 at +6. In the past, she has hit nadir at +12.

If she goes below 200 at PMPS, should I still follow the rule of no insulin, or should I try to give her a little something just to make sure she keeps getting something every 12 hours?
 
People here use one of two dosing methods, the Tight Regulation protocol, or the Start Low Go Slow method. Take a read of the Sticky Notes associated with those methods, and see which you'd like to follow. The answers to dosing depend on which method you are following.
She may or may not hit nadir at +12 today. I've long since given up trying to guess what a cat will do. :p:cat: People who use the cutoff of 200 to start will gradually lower that number, as you can monitor and have the data to do so. You have shot 203 before, so something in the 190's is easily within meter variance. However, that 203 was during the day.
 
Start Slow Go Slow would be perfect for me, especially since I am muddling my way through this.
Instead of trying to anticipate, I will test and follow the guidelines. It does make it easy.

The sticky mentions the following:
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
I have never tested for that, nor do I have the ketostix.

I see mixed information about that saying it can happen at lower numbers and normal kitty behavior, but it seems more likely if the cat is not eating
Bailey is eating playing and eating fine, and her diabetes clinical symptoms are gone.

Do you have any insight on that because I just freaked out reading about it.
 
As I research it, DKA seems like something that won't come out of no where overnight. It seems like there should be some warning signs first.

I will buy some strips tomorrow and begin testing her.
 
Think of Ketostix as insurance. 5 years on insulin, and really ugly numbers at the beginning, and Neko never threw ketones. But if her numbers were higher, I tried to test regularly, just in case. You would worry more if he was lethargic, not eating, or had some kind of infection/inflammation.

Could you add SLGS to your signature? That'll let us know which dosing method you want to use, and help us help you.
 
That make sense. If I saw those kind of symptoms, I would be rushing to the vet anyway.

I will modify my signature now.

Thanks for your guidance :)
 
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