New SS; help appreciated!

[sadye claxton]

I'm reposting here as I have this on the main forum and was advised to post on the Lantus forum! thanks everyone! FWD:

Hi! Okay so first and foremost THANK YOU for your help!! Here's the deal, I've been posting up until now but in case you haven't seen my posts...Bodie is my foster. Diagnosed 4/28/2020. We started on Lantus and went home with a FreeStyle Libre implanted glucometer to get curves. SO I have lots of BG numbers from over the past month that I could record but from what I've been told here I was doing it all wrong, so I've started over. I was wrong in that we are on Lantus and the vet told me "if pre-shot over 300 give 3, under give 2.5, under 250 give 2, under 200 1.5 and 100 give 1, under 100-don't shoot." So needless to say, his numbers were all over the place. She also told me to leave his DM kibble out during the day to free feed on. About 2 weeks ago I completely pulled the kibble after research. He's now only on DM wet food and some boiled chicken treats. I JUST started snacks of Fancy Feast, but I'm thinking of pulling that right now because I don't want to disturb the new numbers.
My questions:
1- can someone look over my SS? I wrote I'm doing "tight Regulation", because we picked a 1 unit dose and have stuck with it. Is that right? (please note...I am doing my best with getting a curve; he is VERY hard to get to sit still for an ear stick, and half the time his ear doesnt bleed; I know i need more numbers, but I'm trying!!)
2-He's starving all the time. Okay to just feed meals throughout the day? Is there a science to how much/little to feed. He needs to gain weight. But we are already way over the "feeding guidelines" for the DM. Purina says give 1 7/8 cans a day (for a 12 lb cat; he's about 10lbs). He's getting two cans a day, plus chicken treats throughout the day
3- I've wanted to add in some Fancy Feast snacks throughout the day to hopefully transition to that cheaper food, but I'm hesitant to throw a new "factor" into play right now as we figure out his dose...but if I don't do it now, will I have to do curves all over again later??

A BIT OVERWHELMED HERE...but SUPER thankful for this forum and all of you who are willing to take your time to look over my stuff and help me help Bodie!! Thank YOU!!!

 

[AmandaE]

Good Morning!

Welcome to the Lantus / Levemir Group

RE: DM Wet Food - DM is a good prescription food for diabetic cats however it is really pricey! You could exclusively use Fancy Feast or Friskies Pates if you wanted to save a little cash, that was recommended to me when I started here and I am glad I made the switch. Generally we like to make sure that food is less than 10% carbs, if you're ever looking for other options that are more affordable Dr Lisa's Food List has a really good summary of the nutritional information of a variety of available wet foods

RE: He's Starving all the time: Due to their inability to effectively produce insulin diabetic cats who aren't yet regulated are unable to use the nutrients from food as efficiently as a typical cat, often they are very hungry at the beginning of diagnosis and need to eat more. Personally I gave Mowgli more food than normal when he was first diagnosed because he was starving. If Bodie is underweight I would say it should be ok to feed extra food until you notice he starts gaining weight... within reason of course. The FAQ section of the FDMB site states that a healthy amount of food for a cat is 15-25 calories per pound of ideal weight (Q2.6.) I think it is ok if you feed him extra.

RE: Tight Regulation: It looks like you're testing enough in the day time for tight regulation but it would be good to see a couple evening tests nightly. I understand that testing is tough in the beginning but evening tests are very important as most cats tend to dip low in the evenings which can be dangerous. Typically it is recommended to at the very least get a PMPS +2 and even better is a +2 AND a before bed test. To better understand Tight regulation I recommend reading and re-reading the sticky describing the protocol HERE and as you gain more experience and more data to ask questions along the way about it. So far to me it looks like you're following TR well, Bodie's numbers are looking pretty good on one unit, because you have seen a number less than 100 in the last couple days TR recommends holding the same dose for 10 days... great job You do need to grab some more night tests though in order to meet TR criteria.

RE Fancy Feast snacks: I say go for it... personally I would even consider switching fully to Fancy feast as it is cheaper than DM... But obviously that is personal preference

It really is SO overwhelming at first but you're doing such a great job already! you're testing, you've converted to a wet diet, and you have your spreadsheet all filled out... awesome!

It would be helpful for you to add a couple things to your signature like what type of monitor you're using and the food that you're feeding, but those are small details.

Good luck

 

[AmandaE]

oh, also... i do feel like it is worth putting your freestyle libre data into the spreadsheet! all data is good data ... just my opinion

 

[sadye claxton]

Good Morning!

Welcome to the Lantus / Levemir Group

RE: DM Wet Food - DM is a good prescription food for diabetic cats however it is really pricey! You could exclusively use Fancy Feast or Friskies Pates if you wanted to save a little cash, that was recommended to me when I started here and I am glad I made the switch. Generally we like to make sure that food is less than 10% carbs, if you're ever looking for other options that are more affordable Dr Lisa's Food List has a really good summary of the nutritional information of a variety of available wet foods

RE: He's Starving all the time: Due to their inability to effectively produce insulin diabetic cats who aren't yet regulated are unable to use the nutrients from food as efficiently as a typical cat, often they are very hungry at the beginning of diagnosis and need to eat more. Personally I gave Mowgli more food than normal when he was first diagnosed because he was starving. If Bodie is underweight I would say it should be ok to feed extra food until you notice he starts gaining weight... within reason of course. The FAQ section of the FDMB site states that a healthy amount of food for a cat is 15-25 calories per pound of ideal weight (Q2.6.) I think it is ok if you feed him extra.

RE: Tight Regulation: It looks like you're testing enough in the day time for tight regulation but it would be good to see a couple evening tests nightly. I understand that testing is tough in the beginning but evening tests are very important as most cats tend to dip low in the evenings which can be dangerous. Typically it is recommended to at the very least get a PMPS +2 and even better is a +2 AND a before bed test. To better understand Tight regulation I recommend reading and re-reading the sticky describing the protocol HERE and as you gain more experience and more data to ask questions along the way about it. So far to me it looks like you're following TR well, Bodie's numbers are looking pretty good on one unit, because you have seen a number less than 100 in the last couple days TR recommends holding the same dose for 10 days... great job You do need to grab some more night tests though in order to meet TR criteria.

RE Fancy Feast snacks: I say go for it... personally I would even consider switching fully to Fancy feast as it is cheaper than DM... But obviously that is personal preference

It really is SO overwhelming at first but you're doing such a great job already! you're testing, you've converted to a wet diet, and you have your spreadsheet all filled out... awesome!

It would be helpful for you to add a couple things to your signature like what type of monitor you're using and the food that you're feeding, but those are small details.

Good luck

thank you SO much for all of this!!!

 

[Wendy&Neko]

Hello and welcome.

As for the Freestyle data, don't bother adding it in for more than the last two weeks. Beyond that is ancient history in dosing terms. Following TR doesn't mean starting with 1 unit, though many cats new to insulin end up starting there cause the starting formula is weight based and that works for an average cat size. TR has implications about when you increase a dose, when you decrease (if they go below 68 on that AT), and the amount of testing you do. Is it possible for you to get tests before you go to bed at night? Many cats go lower at night and we determine how to change the dose based on how low the dose is taking the cat, hence the importance of night time data. Following TR means get the two preshot tests, plus at least one additional test each cycle. TR is a more aggressive (though safe) method than SLGS, but you need to do the testing to make sure kitty is safe. So for the moment, keep giving the same dose (unless she goes under 68) and get some night time tests in and we can evaluate the dose again in a couple days.

Food - if you look at the DM cans, it says "dietetic" not diabetic management. The manufacturer got called on false advertising and changed the name. It's not that great a quality food, though is a validlow carb option if your cat likes it. Many grow tired with it over time.

Is there a science to how much/little to feed. He needs to gain weight.

Yes, feed him more. Many of us feed several mini meals per cycle. Use your scale as a guide and weigh him regularly. Feed a bit more until he gets to the weight the vet says is a good one. Try to feed most of the carbs in the first half of the cycle, when the insulin is strongest.Have you looked at the catinfo website by Dr. Lisa Pierson? She's a vet specializing in feline nutrition and has good tips on feeding and how much a cat should eat.

 

[sadye claxton]

I did read over Dr. Pierson's stuff; we're now in the process of switching ALL our cats to wet food only ! Very informative; thank you!
So I've gotten a few night time readings...I can keep doing those. As for the freestyle libre we had, I entered some of the data. It was eye opening because it was monitoring him overnight too and gave us a curve ( not exact numbers but we could see a range/if he went very low). I can see his lows are almost consistenly at noon and 3am per that curve ( which could be way off now because we had NO consistantcy on the doses/ and were feeding all the time)
BUT, since seeing this, I'm wondering:
-IF I continue the one unit every 12 and just check BG around noon and as close to bed as I can, maybe I can lay off of sticking him so often for awhile?
-OR does he need a slight increase in dose from the data collected the past 6 days
-Looks like though from the curves the FreeStyle Libre gave us, his lows around 3 am are significatly lower than his PM pre shot BG; so maybe he's in a target range during those hours?

 

[Wendy&Neko]

When I click on the spreadsheet link, I get an error message saying it can't find the page. Maybe recheck the link you've got in your signature. Let us know if you are having difficulty with that.

 

[sadye claxton]

When I click on the spreadsheet link, I get an error message saying it can't find the page. Maybe recheck the link you've got in your signature. Let us know if you are having difficulty with that.

uh oh! I just retried..and after the last documentation on the 26th, it skips a few lines and picks back up bc I went from the Freestyle libre implant to the Alpha Trek Meter ( as noted)
lmk thanks!!

 

[Wendy&Neko]

Great, it's working again. Interesting to see how much different the Libre values were from your own meter.

The goal with testing, is to try to find out how low a particular dose is taking him. It's not always the same time for every cat, so you have to find out when those low points (nadirs) tend to happen with Bodie. We determine how to change the dose based on those nadirs. I still see only a couple data points at night, so don't have a good idea how low he's going then. If you see a +2 that's quite a bit lower than the preshot test, it's a good idea to try to get another test that cycle. People often use that +2 test as a guide to whether they need to test again in the cycle. If it's higher than preshot, you can ease off the testing.

If the issue with wanting to reduce the amount of testing is the cost of test strips, you can always switch to a human meter which is much cheaper. Our dosing methods were set up with human blood glucose values in mind.