Boo Kitty 12/22 (386 AMPS) Lemevir and Overnight feeding ideas?

[Adam Roberts]

Last post for continuity: https://www.felinediabetes.com/FDMB/threads/12-4-boo-kitty-amps-410-4-589.239559/

Hi all, Boo Kitty is now on 5U; doing a curve today now that this is his third day on the dose. Wish me luck!

Two q's:

1. Vet and I are discussing switching from Lantus to Levemir. She says Levemir is more potent and longer lasting, so she'd want to bring him back down to 1U. This makes sense to me but I dread the idea of going totally back in time. Any advice from anyone else who has made this switch?

2. Overnight feeding -- Between 3AM - 9AM, BK is unbearable with his hunger. A few weeks ago I got him an auto feeder, which he definitely uses but it seems to be not enough. In the 3-9AM block, he meows incessantly even after the auto-feed. He's getting an entire can of Purina DM during those hours (1/4 can @ 3:30a, 1/2 can @ 6a, 1/4 can @ 8:30a), on top of another entire can throughout the afternoon (1/4 can @ 2pm, 3/4 can @ 8:30p). 2 cans/day is even a bit more than Purina recommends on the pkg. It's also incredibly expensive. I've been debating Fancy Feast per some other posts, but don't want to mess with too many changes at once while we're still struggling to get him regulated. Anyone else successfully navigated overnight feeding?

 

[JaxBenji]

Hi! Hopefully, @Wendy&Neko may be able to stop by regarding the switch to Levemir - I don't think you start down to 1u though but I'll let her guide you.

For feeding, since he's unregulated, I believe he needs 1.5x to 2x his food since he can't absorb nutrients efficiently. I know you mentioned switching to Fancy Feast - if it were me, I'd just switch, save money and have easily available food. Just my two cents. Here's a good food list to use as a start - it's from 2017 - https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Hang in there - you'll find the right dose and figure it out Boo Kitty is lucky to have you

 

[Ella & Rusty & Stu(GA)]

Lev. isn't that much different from Lantus with regard to dosing. A major difference is that the nadir (lowest number of the cycle), tends to be later in many cats. It seems from your spreadsheet (which has gaps, especially at the beginning), that you increased dosage too quickly and by too much at first without following the protocol. Perhaps it might be prudent to start over. (? @Wendy&Neko ?) You may have missed a good dose, and too much insulin can produce high numbers just as too little insulin can. My suggestion would be to start maybe at 1.5 or 2 U and follow the protocol with regard to when and by how much to increase the dose. Are you doing TR? Try to get in more tests during the nighttime cycle. You are missing a lot of data.

Fancy Feast Classic patés might be a good idea. Much cheaper than the prescription food and probably better quality. Try a small portion of food at his bedtime. Maybe try a different feeding schedule. I'm not sure I understand how your feeding times fit into the 12-hour cycle. What times do you shoot? Maybe the largest portion of your "blocks" should be the first serving of the block. Then maybe he'd feel more satisfied and not meow immediately for more food. Don't feed a big portion after nadir (the lowest number of the cycle), but a snack at about +9 often helps keep hunger at bay.

Keep calm and try to be consistent. Best of luck in this "adventure"!

 

[Wendy&Neko]

She says Levemir is more potent and longer lasting,

That's true - in dogs. But cats aren't dogs. We suggest that if you switch you go to 70% of your Lantus dose. So that would be 3.5 units. It's not so much that you'd need that much less insulin, but some cats have a strong reaction to the change, so it's a safety thing. Levemir can have longer duration, in a lot of cats, but not all. You'd still give it twice a day. When Neko switched, we ended up at just a hair (less than 0.25 units) lower dose on Levemir, in spite of starting at 70% dose, we did increase back up almost to the same dose.

I do agree with Ella that there are too many gaps in the spreadsheet. I notice comments that you ran out of strips. I strongly recommend switching to a human meter, especially one where can get strips easily, hopefully in the neighbourhood. It's just not safe to give insulin if you don't know what their blood sugar is at the time. If you do want to stick to the AT, make sure you always have 200 hundred around. Or maybe more. Shipping these days is not reliable. A good reason to have at least a backup human blood glucose meter.

As for food, ditch the DM - there is no value in feeding it. Do you have a 5 compartment autofeeder? More smaller meals might help. Are you weighing him? The scale can help tell you if you are feeding enough food. Given the higher numbers I see, probably not enough. I actually found that raw food was more filing for Neko. Her hunger also drove me crazy at times until I figure out the more smaller meals really helped.

 

[Adam Roberts]

As for food, ditch the DM - there is no value in feeding it. Do you have a 5 compartment autofeeder? More smaller meals might help. Are you weighing him? The scale can help tell you if you are feeding enough food. Given the higher numbers I see, probably not enough. I actually found that raw food was more filing for Neko. Her hunger also drove me crazy at times until I figure out the more smaller meals really helped.

Yes, I have a 5-compartment feeder. It has somewhat helped. I went back to the drawing board last night and as of today am auto-feeding him 0.6 of a can every ~5 hours (2am, 7am, 12pm, 5pm, 9pm). This morning though he still got me up between feedings around 5am and 8:30am. (I went to bed around 1am; sigh....)

What kind of raw food would you recommend? He steals our food all the time (cooked meats, etc) and is also eating tissues again...

 

[Adam Roberts]

I do agree with Ella that there are too many gaps in the spreadsheet. I notice comments that you ran out of strips. I strongly recommend switching to a human meter, especially one where can get strips easily, hopefully in the neighbourhood. It's just not safe to give insulin if you don't know what their blood sugar is at the time. If you do want to stick to the AT, make sure you always have 200 hundred around. Or maybe more. Shipping these days is not reliable. A good reason to have at least a backup human blood glucose meter.

Do you think it's worth starting over, then @Wendy&Neko ? I looked at the Relion prime but decided against it after talking to vet (they pref AT) and being unsure how to compare values btw current AT values and whatever I'd get out of the Relion. I'd need a new spreadsheet too, right?

 

[Wendy&Neko]

Do you think it's worth starting over, then @Wendy&Neko ? I looked at the Relion prime but decided against it after talking to vet (they pref AT) and being unsure how to compare values btw current AT values and whatever I'd get out of the Relion. I'd need a new spreadsheet too, right?

No, I think starting over won't do BK any favours. What I think you should do is get enough data to see what this dose is really doing for him. I'd really like to stress those tests over the night time cycle. If he wakes you up at 5am, grab a test. Hopefully he's not bugging you because he's gone low. Many cats go lower at night. I think another day or two of data will help us see what this dose is going. If the dose is too high, you'd see him diving down at some point. When you see the +2 quite a bit lower than the preshot, like you did last night, it's an indicator that it's an active cycle with some downward movement. So it'd be worth setting an alarm for a later test, or wait until he gets you up.

And no, you wouldn't need a new spreadsheet, we actually like seeing it all on one page. Let us know when you want to switch and we've got some people who can make the change for you. The vets often prefer the AT, but it wasn't that long ago they didn't have them, cause they didn't exist, and had to use human meters. Our dosing methods were designed with human meters in mind, so we actually prefer them. If you vet wants to see the occasional curve with the AT, you can bring it out for those days. But for day to day, use the Relion and save your money.

As for raw food, it does depend on where you live as to what is available. In Canada, there are some great products made in the same area where I live. Like a switch from dry to raw, the switch to raw should be gradual. Though my girl Neko took to it right away. Are you adding some water to the canned food? It helps fill their tummy some more. But the thing we really have to do to help him is get his numbers better. So testing more, figuring out what this dose is dosing will help.

 

[Adam Roberts]

...Are you doing TR? Try to get in more tests during the nighttime cycle. You are missing a lot of data.

... I'm not sure I understand how your feeding times fit into the 12-hour cycle. What times do you shoot? Maybe the largest portion of your "blocks" should be the first serving of the block. Then maybe he'd feel more satisfied and not meow immediately for more food. Don't feed a big portion after nadir (the lowest number of the cycle), but a snack at about +9 often helps keep hunger at bay.

@Ella & Rusty & Stu(GA) Thank you! My intention is to be doing SLGS, which really only began around 11/19. I was getting lots of conflicting vet advice before then (and hadn't fully discovered this forum) prior to then, hence the dirty data. I feed and then immediately shoot at 9:30am/pm.

 

[Adam Roberts]

When you see the +2 quite a bit lower than the preshot, like you did last night, it's an indicator that it's an active cycle with some downward movement. So it'd be worth setting an alarm for a later test, or wait until he gets you up.
...
Are you adding some water to the canned food? It helps fill their tummy some more. But the thing we really have to do to help him is get his numbers better. So testing more, figuring out what this dose is dosing will help.

@Wendy&Neko got it! This makes so much sense...maybe he's waking me up b/c he's going super low. I will try that next. If he is going super low, what then? Reduce his dose? His numbers are so high during the day...

I'm not adding water to the canned food (he's been drinking a pretty normal amt), but can def try that.

 

[Ella & Rusty & Stu(GA)]

Yes, I have a 5-compartment feeder. It has somewhat helped. I went back to the drawing board last night and as of today am auto-feeding him 0.6 of a can every ~5 hours (2am, 7am, 12pm, 5pm, 9pm). This morning though he still got me up between feedings around 5am and 8:30am. (I went to bed around 1am; sigh....)

@Ella & Rusty & Stu(GA) Thank you! My intention is to be doing SLGS, which really only began around 11/19. I was getting lots of conflicting vet advice before then (and hadn't fully discovered this forum) prior to then, hence the dirty data. I feed and then immediately shoot at 9:30am/pm.

Hi again, Adam:
I'm still confused about how your feeding schedule (the new one: 0.6 of a can every 5 hours) coordinates with the 12-hour dosing cycles. You say that you begin the A.M. and P.M. cycles, feeding and shooting at 9:30 A.M and 9:30 P.M. In the A.M. cycle that would mean that you are feeding the first meal of the cycle and giving insulin 2 1/2 hours after he has eaten 0.6 of a can at 7 A.M. This suggests to me that the food given at 7 A.M. is influencing BK's pre-shot numbers, causing them to be higher. With Lantus, "onset" (the time that it takes for the insulin to begin to kick in and work on the numbers), is usually about 2 hours after shot time (11:30 A.M.on your schedule). So ideally you should expect the numbers to get lower from 11:30 A.M until the lowest number of the cycle--the "nadir"--which let us say for the sake of illustration might be around 3:30 P.M. But you are giving another 0.6 can portion of food at 12 P.M.--1/2 hour after onset. Might this create an overload for the insulin to work properly?? [ @Wendy&Neko ] I really don't know, but it just seems weird! After nadir most people cut down on food, often limiting it to a snack somewhere around +9. But your feeding schedule for the A.M. cycle calls for another 0.6 of a can at 5 P.M. (2 1/2 hours after nadir) and 9 P.M. (1/2 hour before shot time!).

Timing is so important when dealing with FD, and you also have to take into consideration your own schedule. Is it possible to re-think your feeding schedule to get it more in sync with your own?

Happy Holidays to you and Boo Kitty!

 

[Adam Roberts]

@Ella & Rusty & Stu(GA) thank you this context is super helpful. I hear your point re: timing and guess I wasn't putting all the pieces together. I was trying to spread out his food evenly over more portions to go easy on his pancreas, given what other folks have said. I just charted out something (assuming 9am/9pm for sake of simplicity). What do you think about the below? Look better?

 

[Wendy&Neko]

That's a great way of showing a possible feeding plan. Is it possible to change the later snacks to before or at at nadir? After nadir, the insulin action is normally slowing down. Think of it like a car coasting towards a stop sign after you take the foot after the gas. Any carbs after that will cause the insulin to slow down, like putting on the brakes, and cause the insulin action to stop prematurely. This gives you shorter duration, and higher numbers at preshot. So if you shoot at 9/9, a snack at 11 (+2) and +5 might be better. Figuring out feeding is a bit of trial and error for exact timing that works for a particular cat.

 

[Ella & Rusty & Stu(GA)]

Your chart is so helpful! And I think Wendy's suggestion for the timing of the snacks is excellent. My GA kitty, Rusty, was on Lev., and his onset usually came around +4 (the later onset is typical for Lev. and a great advantage of Lev. over Lantus: numbers keep rising after the shot until onset, so if your cat has a too-low number at AMPS, you don't have to worry (too much), because his numbers will presumably rise before onset). I always fed a snack at +5 and a small snack at +9. Rusty's nadir was pretty close to mid cycle (+6), but many cats on Lev. have a late nadir. Every cat is different (ECID, as they say).
You will have to experiment with timings and amounts of food. Lots of challenging fun!

 

[Adam Roberts]

Thanks @Ella & Rusty & Stu(GA) & @Wendy&Neko. So, maybe something like below? I wonder if there's anything I can do to get him more feedings btw 3am-8am; that's when his hunger is really at its worst. FWIW, I did his BG at 3:30am today and his BGC was quite high (567), so it seems our theory that he's running low overnight isn't the case.

I also just got his ILG1 growth factor test results back from the vet and unfortunately the diagnosis is Acro. So, doing a lot of processing...

 

[Wendy&Neko]

Sorry to hear about the IGF-1 number. Do you know what it was? Insatiable hunger is one of the hallmarks of acromegaly. And feel free to ask any question, I know I had a lot at this point.

I fed Neko more than 2 meals a cycle, more like 3 or 4. It's easy to do with the autofeeder and got her associating food with the feeder instead of me. If you have to feed late in the cycle (and I had to do the same), try to feed something that is zero carbs. You can either pick up some zero carb canned food, or bake/boil a chicken breast and cut it into small pieces. It can also be used for test treats if you want.

Now that you know what you are dealing with, you might want to investigate cabergoline as a treatment, unless you can afford radiation therapy or hypophysectomy (surgery to remove the pituitary). The latter both involve travel unless you live where it's available. For me it was a 3 day car ride each way. Another thing to think about is whether it's possible to switch to TR for dosing or modify SLGS somehow to get faster increases so you can stay ahead of the resistance. I can help you some options if you can't do TR.

 

[Adam Roberts]

@Wendy&Neko thanks. Super jarring but honestly this is what I've been suspecting for a while. His IGF-1 is 348. I see in the Acro thread that folks are posting IAA numbers as well. I'm going to do a bit more research but am not likely to do radiation. The vet recommended the goal now be to get his BG in 250-400 range moving forward; she doesn't think it'll ever go much lower than that. I've not heard about Cabergoline but will research. Just going to process / let this news sit for a bit for the next few days. Happy holidays to you and yours.

 

[Ella & Rusty & Stu(GA)]

Hi Adam,
Sorry to hear about the Acro diagnosis. Wendy is on top of this, and others here who have acro kitties now or have dealt with acro will have lots of good advice. I have no experience, but I will be following your posts and offering encouragement.

With regard to the food and timings, I can say that it can take a few days for a change in anything to take effect and produce the desired results.
Hang in there and you will learn so much that will help Boo Kitty .

Happy Holidays to you and your family

 

[Wendy&Neko]

The vet recommended the goal now be to get his BG in 250-400 range moving forward; she doesn't think it'll ever go much lower than that. I've not heard about Cabergoline but will research.

That is wrong is so many ways. You just need to get to the right dose. Acromegaly is hard on kidneys by itself, keeping BK under renal threshold is a much better goal. I'm going to link a couple of spreadsheets of acros on this forum, all taking cabergoline, one very recent. Starting with Moe's SS - now a model of regulation, a little over half a year on cabergoline. Amethyst was quite a young kitty when diagnosed with acromegaly, here is her SS. She's been on insulin for 4 years, most of that with awesome numbers, on cabergoline over 2.5 years. Here is Willow's SS, she is in week 2 of cabergoline.

Cabergoline does more than just reduce the dose - it's part of reducing the growth hormone output and some of the side effects it has. Here was my original post on cabergoline, with several caregivers adding to the conversation. This second thread also has some good information, specifically look at Paula's description of the benefits to her girl. Tillie contacted the authors of the South American study on cabergoline, and found out they've been using it a lot. More info here, and there.

Moe is still on Lantus, Amethyst and Willow switched to Levemir, which is generally better for higher dose cats - from the sting and duration point of view. Though Moe is working the Lantus just beautifully!