? Advice for his swinging numbers - and how to dose

[Ramon's mom]

Its been a while since I was here but I need some advice. I have kept his spreadsheet up to date all along. My cat Ramon has other conditions that appear to make it difficult to regulate his BG. I generally give full doses for any number over 100 but lately he has been getting numbers below 100 often. I skip the dose and then keep testing until it's high enough to give a shot. Then I have to wait 12 or more hours and slowly move him back to his regular schedule (10:30 am and pm). Since this approach makes him swing up, usually, I tried lowering the dose but that didn't work. In the last three days he had a shot on Thursday evening, then Friday afternoon and then this morning. And now he's too low to get an evening dose. He's eating normally, so I don't think it has to do with food. I'm hoping that experienced Lantus users can give me suggestions on how to handle this, especially understanding that he never gets steadily under control no matter what I have tried. In all his swinging around with numbers he has never had high ketones.

 

[Bron and Sheba (GA)]

One of the first things I would do is choose one of the two dosing methods and follow that.
Here is a link methods. This will take a lot of the guess work out of it all. https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Another observation is you are not testing enough. Lantus is dosed on the nadir, or lowest point in the cycle . Looking at your SS there are not many tests done during the cycles at all and vertically none in the pm cycle when cats often drop lower at night.
The pm cycle is just as important as the am cycle and unless we see tests during that cycle, we have no idea if Roman is dropping low and bouncing up the next day or not. But looking at the rainbow of colours in the preshot BGs, I would say he is dropping low and bouncing.
I would drop the dose to 3.75 units bd and see if you can shoot both cycles. But you need to be getting those tests in during the cycles otherwise it is all going to be stabs in the dark and guesswork as far as the dose goes.
At the very least I would recommend you get a before bed test in every night. If that before bed test is lower than the present BGi would set the alarm and get up and check a couple of hours later to keep him safe. And at least one test in during the day cycle if possible.

Are you giving snacks during the days and evenings as well as the Preshot meals?

when you decide on a dosing method, would you mind putting it into the signature please.......thanks.

 

[tiffmaxee]

You need to get some tests after PMPS as he might be going low at night. We only see half of the picture. Looks like you aren’t following either of our dosing methods.

 

[Ramon's mom]

One of the first things I would do is choose one of the two dosing methods and follow that.
Here is a link methods. This will take a lot of the guess work out of it all. https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Another observation is you are not testing enough. Lantus is dosed on the nadir, or lowest point in the cycle . Looking at your SS there are not many tests done during the cycles at all and vertically none in the pm cycle when cats often drop lower at night.
The pm cycle is just as important as the am cycle and unless we see tests during that cycle, we have no idea if Roman is dropping low and bouncing up the next day or not. But looking at the rainbow of colours in the preshot BGs, I would say he is dropping low and bouncing.
I would drop the dose to 3.75 units bd and see if you can shoot both cycles. But you need to be getting those tests in during the cycles otherwise it is all going to be stabs in the dark and guesswork as far as the dose goes.
At the very least I would recommend you get a before bed test in every night. If that before bed test is lower than the present BGi would set the alarm and get up and check a couple of hours later to keep him safe. And at least one test in during the day cycle if possible.

Are you giving snacks during the days and evenings as well as the Preshot meals?

when you decide on a dosing method, would you mind putting it into the signature please.......thanks.

In the first year I tried both the dosing methods and neither works for him because he never stabilizes. And I stopped testing during the mid cycle except when he was under 100 at injection time because he has no steady nadir. Often his low would be right at the dosing time but not always. It literally is never the same, and some days never even low. I also have my own medical issues which include sleep problems so I don't test during the night because of that. His regular nighttime test/shot is just before my bedtime (except tonight I guess). As I mentioned, the standard methods supported here do not stabilize him (you can see on my earlier year spreadsheets). Maybe I need to go back to Prozinc? It didn't work very well before when I tried it.

I did try lowering his dose last week but he bounced up anyway. He does get snacks and Preshot meals every day.

 

[Ramon's mom]

You need to get some tests after PMPS as he might be going low at night. We only see half of the picture. Looks like you aren’t following either of our dosing methods.

As I mention in my reply to Bron and Sheba, two years ago I stopped attempting either method because they didn't work at all for him in previous years of this. Its one reason I stopped coming to this board. No one was able to help me stabilize him. He gets fed up with all the ear pricks as it is, so the extra testing isn't worth risking him avoiding me especially since he has no reoccurring nadir. It literally swings all through the day. There is nothing standard about how he responds to insulin. I mostly have stuck with insulin every 12 hours but lately I can't because of his readings.

 

[Bron and Sheba (GA)]

In the first year I tried both the dosing methods and neither works for him because he never stabilizes. And I stopped testing during the mid cycle except when he was under 100 at injection time because he has no steady nadir. Often his low would be right at the dosing time but not always. It literally is never the same, and some days never even low. I also have my own medical issues which include sleep problems so I don't test during the night because of that. His regular nighttime test/shot is just before my bedtime (except tonight I guess). As I mentioned, the standard methods supported here do not stabilize him (you can see on my earlier year spreadsheets). Maybe I need to go back to Prozinc? It didn't work very well before when I tried it.

I did try lowering his dose last week but he bounced up anyway. He does get snacks and Preshot meals every day.

How about you give one of the dosing methods another try and post daily so we can help you.?
That would be my suggestion

 

[Ramon's mom]

You need to get some tests after PMPS as he might be going low at night. We only see half of the picture. Looks like you aren’t following either of our dosing methods.

Yes I no longer follower either method because they never worked for him in previous years. Does that mean I can't get advice?

 

[Ramon's mom]

How about you give one of the dosing methods another try and post daily so we can help you.?
That would be my suggestion

Is there anyone here experienced with cats who do not respond to those methods? Or who doesn't stabilize due to his other conditions? I'm not too keen on going over old ground again that I tried for quite a long time.

 

[Bron and Sheba (GA)]

I have just looked back over your previous SS of 2019 and 2020 and I don’t really think you stuck to the dosing methods properly. There was a fair bit of changing the dose.
I understand you have issues of your own that make some of the testing difficult but maybe we can work around those so we can help Roman
The people on this forum dose by the two dosing methods. I would urge you to try one of them again.
We are happy to help you.
I would caution you about some of the other sites out there that offer dosing advice. Some of them are not safe.

do hope you will stay and let us help you.

 

[Marina & Chico]

I am very happy you found your way back to the forum we found here a lot of support and help to get Chico’s numbers in better values and more stabilized, with that being said i understand that each cat is different and each cat takes different amount of time and effort to stabilize. The forum provides the 2 protocols which give results to most cats and therefore i understand why nobody would be willing to give advice outside the protocols (i am too new at FD to even attempt to give dosing advice).
I understand you have health issues which don’t allow you to test too much, therefore i would recommend you to check the SLGS method, which is developed specifically for cases when people cannot test too often. Regarding night time testing, maybe it is worth trying to push the shot time a couple of hours earlier to make it possible to take a +2 test before going to bed?

lantus likes consistency: shooting at the same time, the same dose. By following the protocols we exclude some of the variables that might influence the BG (for ex shooting at different times, giving variable dose etc) which makes it easier to understand how is the kitty reacting to that specific dose of insulin.

i really recommend you give the protocols on the forum another try and put on the patience pants, the minimum it would give is a clear guidance on how to act in specific cases without having to guess.
Take care a good luck with Ramon’s FD path

 

[SashaV]

What happened in April last year?
I'm not seeing any dose protocols being used, you're skipping when you get a green or lower blue number, and messing around with his dosage. It's like you've been doing prozinc dosing with a depot insulin, and that definitely doesn't work, as you've seen.
I'd also recommend you give it at real shot, following the guidelines strictly and posting daily.

When you don't shoot on lower numbers you miss out on the entire point of using a depot insulin. The point is to shoot low to stay low, using the depot to our advantage.

Think of a glass of water, the glass is the depot, water is insulin. You work your way up filling the glass with water, you find a level that's working for him and he is seeing great numbers. Then you skip, the water drains, and by next shot the level of water is lower than usual and he goes higher. Every time the water level is low, it takes time to fill it back up. That's what we mean by consistency, we need to keep the glass filled to that level that fits your specific cat. Without following a protocol your glass is shattered and you're trying to fill the pieces with water. The water level can never be obtained in a shattered glass, and you constantly need to refill it. A lake drains faster than an ocean.
The protocol keeps the glass together and a good level of water in it.
I don't know if it makes any sense at all, but not treating a depot insulin like it's depot, will not get you any results.

So give it a real shot and post daily. Let us help you!

 

[Sue and Luci]

I have to agree with the other responses above. It will really help in the long run to adapt one of the dosing methods and give it a fair shake. That means not skipping doses when there's an unexpected pre-shot number; getting mid-cycle tests - yes in the daytime and at night.

Here are a few of the general guidelines from the TR dosing method for your consideration:

• Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles). (you're way past this point now).
• Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
• Adjustments to dose are based on nadirs with only some consideration given to preshot numbers. (this is why we don't make that call at pre-shot time, unless there's a really low number)...If I get a nice low green I say 'shoot low to stay low'

You can read more here: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I hope this is helpful...please post every day so that these kind people can help you

 

[Summer and Susie (GA)]

I understand your frustration with the varying numbers but I do hope you will stick around and let these fine folks help you. I, too, have sleep problems. Don't sleep well at night and can't seem to nap during the day. I have Susie set for 6am and 6pm shots (Lantus) just so I can give her a +2pm test before bed. If she looks like she might go lower I make myself set the alarm clock and get up and test around +5. No, it is not fun but it is the only way to make sure our kitties are safe. You should pick a dosing protocol. TR or SLGS. Most folks do the TR but I am on SLGS because I want to give Susie more time to adjust to each new dose and she sometimes won't show a change for many days. And, no, it is not fun to get up at 5:30 in the morning to test, shoot and feed at 6am but I do it because I know how important it is to give the shots, consistently, at the same time each day. Hope you will hang with us. Everyone here is supportive. Would love to know your first name, Ramon's Mom.

 

[Ramon's mom]

What happened in April last year?
I'm not seeing any dose protocols being used, you're skipping when you get a green or lower blue number, and messing around with his dosage. It's like you've been doing prozinc dosing with a depot insulin, and that definitely doesn't work, as you've seen.
I'd also recommend you give it at real shot, following the guidelines strictly and posting daily.

When you don't shoot on lower numbers you miss out on the entire point of using a depot insulin. The point is to shoot low to stay low, using the depot to our advantage.

Think of a glass of water, the glass is the depot, water is insulin. You work your way up filling the glass with water, you find a level that's working for him and he is seeing great numbers. Then you skip, the water drains, and by next shot the level of water is lower than usual and he goes higher. Every time the water level is low, it takes time to fill it back up. That's what we mean by consistency, we need to keep the glass filled to that level that fits your specific cat. Without following a protocol your glass is shattered and you're trying to fill the pieces with water. The water level can never be obtained in a shattered glass, and you constantly need to refill it. A lake drains faster than an ocean.
The protocol keeps the glass together and a good level of water in it.
I don't know if it makes any sense at all, but not treating a depot insulin like it's depot, will not get you any results.

So give it a real shot and post daily. Let us help you!

One of the biggest problems with trying the depot method is that it doesn't take into account how he swings high and low. He is not swinging because of what I am doing. He did this when I was following the method closely at the beginning. So I will end up with the same problem I had last time, that there is no advice on how to handle when he drops down low. At least not that I can see. Except for what I have been doing which is to lower the dose or skip. And as I have said earlier, he has no stable nadir time. Most often his lows were always right @ dosing time anyway.

 

[Marina & Chico]

One of the biggest problems with trying the depot method is that it doesn't take into account how he swings high and low. He is not swinging because of what I am doing. He did this when I was following the method closely at the beginning. So I will end up with the same problem I had last time, that there is no advice on how to handle when he drops down low. At least not that I can see. Except for what I have been doing which is to lower the dose or skip. And as I have said earlier, he has no stable nadir time. Most often his lows were always right @ dosing time anyway.

What you describe is a typical unstabilized diabetic cat, we have all been there for more or less time

 

[tiffmaxee]

Some cats do nadir late in the cycle. Some cats double dip. One nadir earlier and another before the next shot. Then they start to head back up. If lower at preshot but safe to shoot feed higher carb food and see what that does, not hc but maybe 10-15%, mc. If too high then mix lc with a little of the mc. It takes a little experimenting.

 

[SashaV]

One of the biggest problems with trying the depot method is that it doesn't take into account how he swings high and low. He is not swinging because of what I am doing. He did this when I was following the method closely at the beginning. So I will end up with the same problem I had last time, that there is no advice on how to handle when he drops down low. At least not that I can see. Except for what I have been doing which is to lower the dose or skip. And as I have said earlier, he has no stable nadir time. Most often his lows were always right @ dosing time anyway.

What you're experiencing isn't unusual at all... look at others people's spreadsheets.. we all experience bouncing. Nadir is never the same, and won't be. A blood glucose is always moving, it's never constant. I really think you should give it a try. He did great last April, he can be regulated, it'll take some time now, since he's probably a bit insulin resistant. We all experience lows, highs, low preshots. Nothing of what you're saying is new to me, and I've been in this game a lot less time than you... so give it a shot!

 

[SashaV]

And there isn't no depot method. Your insulin is depot. Weather you are using the protocols or not, your insulin is still depot. It act like a depot. And dosing on preshots, especially when you're not testing is very very dangerous. You're not treating it as a depot insulin, but like an in and out insulin.
For his sake you need to listen. I know you've been doing this a long time, and it must not feel great having to learn all over again. But we're only trying to help you. If you learn to dose him right, it will pay off.

 

[Ramon's mom]

What you describe is a typical unstabilized diabetic cat, we have all been there for more or less time

Yes you are correct. And he has been this way the entire time whether he was on a strict dosing protocol or not. That is why I do not test all day anymore. I need to make sure he will continue to cooperate with testing as it is. He is clearly tired of the whole routine and will hide from me. It never got under control. What people think was under control last spring was a time he wasn't eating much at all. That always brings his numbers down. I guess I could feed him less and see what happens, but I don't think that is wise as he has other health conditions. I'm kind of disappointed that this board only pushes these 2 protocols and no-one here seems to offer anything for a cat they don't work for.

 

[tiffmaxee]

I’m sorry you feel that way. We are science based and use what we know works. Some cats just don’t get good control no matter what you do. When our methods don’t work for a CG they adjust as needed but we can’t make recommendations like that as we are not with you and your cat. There are too many variables and we want to keep the cats safe. I hear your frustration. You have been at this for a long time but did have breaks with OTJ periods.

 

[Marina & Chico]

So sorry you feel that way as well... what you call “this board” is actually a bunch of people from all over the world having cats all over the world with very different FD experience nonetheless our voices are almost entirely synchronised - when you consider this, there must be some reason in this board.
The protocols dose based on nadir value and not preshots, therefore i totally understand why nobody wants to take the risk of giving you dosing advice without knowing what is happening during the cycle and it has nothing to do with people not wanting to help you and Ramon. Hope you see it that way as well

 

[Margaret and Pearl (GA)]

Hi! If I can chime in, I know the past (and even present) has been difficult for you with dosing and getting Ramon stabilized. It looks like he indeed is not consistent. But at the same time, your method isn't consistent either.

My cat Pearl was diagnosed at Christmas of 2020. It has been scary and tough to get her regulated, but I followed the advice given to me here on the FDMB - to the letter, never deviating. At times I wondered if it was best or not, but I thought to myself - "these people have 20+ years of experience with feline diabetes. They have seen most EVERYTHING. I am going to buy in to this and trust and go with it whole hog". I am so happy I did. You can see how well Pearl is doing now, and I have learned things I never thought possible along the way.

I know you say he can't stabilize - but that likelihood is next to zero. If he can't stabilize, he literally would be like ONE IN TEN ZILLION cats. So the probability is highly unlikely. If there are other medical issues competing with stabilization, the admin experts on this site are also trained (and have the experience) to ferret those things out.

So, my advice: pick SLGS or TR and stick with it completely for at least 6 months. Do all the BG testing required, adjust the doses as you are instructed, post on the FDMB daily and ask every single question you have, and follow all of the admin advice given, and....try to turn your brain off (lol, hard for me to do, too!). You've been on this journey long enough that committing whole heartedly to 6-month test of just ONE method isn't going to hurt anything. And honestly, getting other people to look at your situation when you are following a certain protocol will give you a LOT more information and learning - more eyes on your cat and his patterns will help get you out of your rut too (I am preaching to myself - I can get stuck in a mental rut, and I feel you may be there too, yes?, with not knowing how to get him stabilized).

I recommend the advice given here whole heartedly. My cat would be dead if not for this group and this advice, guidance, and all the learning I've done. I think if you can commit to either SLGS or TR completely - and ask questions where you aren't sure, and post daily and follow advice - then you are in for a BIG PLEASANT SURPRISE with your cat and his BG regulation. And also...if not, what did it hurt to try? And also...if not, you will have other sets of eyes seeing THE SAME THINGS you do and able to offer medical advice on what to do next (right now, you are the ONLY EYES seeing what you say are problems with your cat - you need some other people to see what you see. The only way to do that is to get on a program and follow it).

Hope this encourages you. You can do this!!

 

[Wendy&Neko]

If you are finding you have to skip doses because you aren't comfortable shooting certain numbers, it's better for the safety of the cat to reduce the dose. I would go to 3.75 units again.

As for stabilizing, I would have had serious envy of Ramon's spreadsheet the first couple years I was here. It took Neko over a year to stop bouncing to reds. Some cats just take longer to settle down. What didn't work in his first year could work now. And my girl also nadired all over the place, on Lantus it was anywhere from +3.5 to +13 for her nadir. I stuck with TR, and eventually got her more or less regulated. A switch to Levemir also helped flatter her out. It may be something for you to think about.

 

[Sienne and Gabby (GA)]

Like Neko, Gabby's FD was not easy to manage. She could dive and bounce with the best of the kitties here and it was like that for 6.5 years. Everyone here does their best to learn and to pass that knowledge forward. One of the the points I try to emphasize when the topic of nadirs comes up is that they can and do move. Gabby had an early nadir -- generally at around +3, except when it wasn't.

I obviously don't know how you were dosing prior to 2019. It didn't look to me like. you were following any particular dosing method from 2019 on.

In response to your comment about food, I would not reduce the amount you're feeding Ramon if his weight it good. You can adjust the carbohydrates. Many cats do better on a diet that is closer to the 10% range of carbs. Or, as Wendy noted, decreasing the amount of insulin you're dosing is also an option.

How can we help?