? Mimis finally lower but I need help!!’ 9/6 AMPS104 +2 84 PMPS 186

Mimis mom

Mimis mom

Member Since 2019
https://www.felinediabetes.com/FDMB...er-dose-what-is-going-on.252501/#post-2849036


Ok here’s where I always run into confusion. She’s dropping. Which means her insulin is too high right???
This is where I get confused about reductions.
When her numbers are like this- I’m recommended a carb intervention- luckily I’m home for a little bit more ans can come back but what if I had to go to work all day? If carbs will interject in her BG numbers how will I ever know if she ever fell below 40 on her own if I prevent it with high carbs. Should I wait and see if she falls below on her own? Isn’t that also dangerous? At times before when she’s fallen it was because I didn’t get a +1 or 2 and checked her at closer to nadir with her regular low carb food ans saw her numbers tank to dangerous levels. Now I’m advised at +1 oe +2 to see how her cycle will go and proactively leave out higher carb food if I’m not around but then how do I know if she earned a reduction? What if she I didn’t leave high carb ans she only fell to 50 and that’s it?or what if she fell to 30? I will never know if I give her high carb food before she has a chance to drop? This is where TR gets tricky..

does that make sense?
What if I’m gone and she falls below 40? Her +2 is telling me that could be a real possibility right? So how do i follow TR when I got a +2 and it’s falling downward and I can’t get a +6

I know I said a lot but im trying to phrase it well.

@Sienne and Gabby (GA)
@tiffmaxee
@PerfumedCatMom
@Chris & China (GA)
 
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Rosa, I have a couple suggestions.

First, breathe! Mimi isn't in low numbers. When you see a lower number than preshot, that often indicates an active cycle, but not necessarily one where she will drop under 50, so don't automatically panic when the +2 is lower. You have a couple of choices, depending on how carb sensitive you find Mimi to be. You can feed a couple of teaspoons of LC and test again at +3. If you have found in the past that LC gets Mimi surfing (staying flat) great! With many kitties, a little of their usual food earlier in the cycle helps prop them up through onset and into when they hit nadir. If in the past, you've needed to use MC, then give her a teaspoon or two of that, and test again at +3. Notice that I mention testing again at +3 regardless of what food you feed.

Which brings me to my second suggestion, it is always helpful to you and others who may offer help, to have you record in your remarks on the SS what % carb you fed, and when, so that when we look back, we can see what worked and what didn't, when you get active cycles.

My third suggestion, is the best way to manage your fear of "what ifs" like you are asking about, is to use weekends and days when you don't work to gather more information on how your cat responds to the insulin and carbs. That will give you more confidence to make decisions of what food to leave for her when you are not home to test as often.
 
Christie & Maverick said:
Rosa, I have a couple suggestions.

First, breathe! Mimi isn't in low numbers. When you see a lower number than preshot, that often indicates an active cycle, but not necessarily one where she will drop under 50, so don't automatically panic when the +2 is lower. You have a couple of choices, depending on how carb sensitive you find Mimi to be. You can feed a couple of teaspoons of LC and test again at +3. If you have found in the past that LC gets Mimi surfing (staying flat) great! With many kitties, a little of their usual food earlier in the cycle helps prop them up through onset and into when they hit nadir. If in the past, you've needed to use MC, then give her a teaspoon or two of that, and test again at +3. Notice that I mention testing again at +3 regardless of what food you feed.

Which brings me to my second suggestion, it is always helpful to you and others who may offer help, to have you record in your remarks on the SS what % carb you fed, and when, so that when we look back, we can see what worked and what didn't, when you get active cycles.

My third suggestion, is the best way to manage your fear of "what ifs" like you are asking about, is to use weekends and days when you don't work to gather more information on how your cat responds to the insulin and carbs. That will give you more confidence to make decisions of what food to leave for her when you are not home to test as often.
Click to expand...

thank you for responding!!
I think when she’s had active cycles in the past I did leave notes but not as diligent as when she was first diagnosed. I’ve always not given her the chance to drop and just went in with medium carb straight away. Sometimes she’s carb sensitive ans I think sometimes she’s not? Or is that not a thing either you are or you aren’t?
My instinct from over the years of her being a sugar kitty is she can handle numbers with her Lc but then if you look at the SS I’ve noted there was a time when LC didn’t work. So it’s hard to know?
 
I’m at least glad her depot is working and her numbers are finally dropping… she hasn’t surfed in weeks
Is it the depot?
She also will likely have a bounce.
I just want to know if she earned a reduction if I can’t get a number below 40 - what if she hits that or would have hit that if she didn’t have food?
 
Are you using an autofeeder for Mimi? I can't remember what your usual feeding schedule is like. In general, no, you don't take a reduction on speculation that you may or may not have missed it.
 
Rosa, I have an additional suggestion - you may want to think about what your goals are for Mimi. Depending on what your goals are, you may find that following SLGS dosing method is more suitable for you.
 
Well do you think she could still go into remission? Are there sugar kitties that have after her time?
 
I didn't get a notice that you tagged me. Sorry.

Christie provided great information -- especially the breathe part. Please remember, there's a 20% variance with your meter. Your AMPS and +3 are essentially the same numbers. A +3 of 84 is pretty safe territory.

My situation with Gabby was similar to yours. I have a full time (more than full time) job and I was Gabby's sole caregiver. I arranged shot times so I could get a few tests before I left the house since Gabby had an early nadir and her numbers could plummet. If she was diving, she got loaded with HC and I have a timed feeder that I would also use to keep her carbs bumped up if needed. She was also a longer term diabetic and I was only using TR. SLGS was not being used when we first started out.

You need to make a decision about which approach will work best for you and for Mimi. She was diagnosed almost exactly 3 years ago. The reality is that with Lantus, a good percentage of cats go into remission within 6 mos of starting insulin. Fewer and fewer cats will go into remission as time passes. I can recall only one cat that went into a first remission after 2 years. As much as I know you want Mimi to go into remission, that window may be closed. Whether the window is nailed shut or not, only Mimi and her pancreas know for sure. What I would encourage you to think about is keeping Mimi's numbers below renal threshold. You've largely been doing that. Since diabetes is hard on the kidneys and renal disease is a problem for many cats as they age, keeping numbers below the mid-200s and adding water to her food (if you're not already doing so) and perhaps even using a water fountain to encourage her to drink, will be added protection for her kidneys.
 
Sienne and Gabby (GA) said:
I didn't get a notice that you tagged me. Sorry.

Christie provided great information -- especially the breathe part. Please remember, there's a 20% variance with your meter. Your AMPS and +3 are essentially the same numbers. A +3 of 84 is pretty safe territory.

My situation with Gabby was similar to yours. I have a full time (more than full time) job and I was Gabby's sole caregiver. I arranged shot times so I could get a few tests before I left the house since Gabby had an early nadir and her numbers could plummet. If she was diving, she got loaded with HC and I have a timed feeder that I would also use to keep her carbs bumped up if needed. She was also a longer term diabetic and I was only using TR. SLGS was not being used when we first started out.

You need to make a decision about which approach will work best for you and for Mimi. She was diagnosed almost exactly 3 years ago. The reality is that with Lantus, a good percentage of cats go into remission within 6 mos of starting insulin. Fewer and fewer cats will go into remission as time passes. I can recall only one cat that went into a first remission after 2 years. As much as I know you want Mimi to go into remission, that window may be closed. Whether the window is nailed shut or not, only Mimi and her pancreas know for sure. What I would encourage you to think about is keeping Mimi's numbers below renal threshold. You've largely been doing that. Since diabetes is hard on the kidneys and renal disease is a problem for many cats as they age, keeping numbers below the mid-200s and adding water to her food (if you're not already doing so) and perhaps even using a water fountain to encourage her to drink, will be added protection for her kidneys.
Click to expand...


I remember you saying Gabby hit nadir early. How do I know if Mimi does or not or how did you learn gabby did?
I think Mimi is at the +6 mark but it’s hard to tell?
So it’s possible the other method might be better for her because she probably not going into remission. (It’s been 2 years, but then again what’s the difference after 1 year)
I have to check out SLGS and see what the main differences are.
I think I should plan the future as if she wasn’t going into remission and maybe hire a more regular care giver to help me so I can start living a little again.. I don’t go anywhere- my days revolve around Mimi snd I know if it was up to her she would probably say “it’s ok mommy. I’m not scared to cross over I stay here for you” as I think all animals feel. They don’t worry about the past or future. They enjoy every moment and mortality to them is relative. As long as they have nice humans that show affection, respect them and make sure they are fed, they are content, complete ans happy. whst I don’t ever want her to experience is suffering.

I would never keep her alive if she was truly suffering, but she’s not she’s just living her best kitty life.
 
Christie & Maverick said:
Are you using an autofeeder for Mimi? I can't remember what your usual feeding schedule is like. In general, no, you don't take a reduction on speculation that you may or may not have missed it.
Click to expand...
Yes I am
So the feeding schedule has always been something I’m never confident about.
In the beginning I just fed her ever 2-3 hours all day every day: auto feeder obviously
But then I learned I didn’t need to do that, so the last year I’ve been feeding her PS, +1 or +2 (maybe both) then one more time before +6. So like+4 or +5. Or maybe even +6 (hope that made sense)
When I work it’s exact like (PS, +2, +4 +6) but the days I’m off I’ve for sure not been on track of exact hour- still she doesn’t eat anything past +6 (maybe a tiny snack if I’m around and she’s meowing at me)
So she eats about 3 different times PS to +6 And the time can vary based on my laziness or schedule. She eats a raw formula still which I think is 0 carbs if I’m not mistaken. The ingredients are only chicken, heart, liver. Not even added vegetables thst make up “5 percent” this is all animal.
I always had extra water and make sure there’s water stations all over.
Also because of the raw meet it’s a lot of times bloody (gross to me but yum yum to her Batman the other cat) and she’s always slurping it all up. She can always eat. She’s kind of piggy in that way which might be why she got the betes in the first place. Her brother never overeats and so he would walk away (to take a break) and she would finish his food. He’s someone thst I can free feed. Mimi even before the illness needed a schedule (but I didn’t pay attention to it and just thought her extra flub was cute and normal to her breed?) every advice I can give to a cat owner now is “if they are overweight, get them to a good weight because they will likely get diabetes”
 
Testing and getting curves is the way to determine where onset and nadir occur as well as what kind of duration you're getting. I was a testaholic. I like data. If you look over Gabby's spreadsheet you'll get a sense of her trends. Also, remember that nadirs can and do move around. It's not a fixed point it's more of a where the numbers fall most of the time.

Some of the differences between the dosing methods:
  • reductions are at 90 (not 40)
  • you do not need to test as aggressively. With TR, the expectation is your pre-shot tests and a minimum of one test per cycle. Most people test a lot more. With SLGS, the minimum is the same. You will want to run a curve every 7 days to evaluate the dose.
  • with TR, you evaluate whether to increase every 3 days (vs every 7 days with SLGS)
Of the top of my head, those are the major differences.

We all make sacrifices to manage our cat's diabetes. I had a couple of occasions when I cancelled plans because I needed to be home to monitor. I also had great friends who were cat people and were fine with making a stop if I wanted to run home and get a quick test. There were times that I needed to travel. I had a pet sitter both in Chicago and in Columbus who I trust implicitly. You do need someone you can rely on if you have to or want be out of the house and to not resent having a diabetic cat. It's a balancing act.
 
Sienne and Gabby (GA) said:
Testing and getting curves is the way to determine where onset and nadir occur as well as what kind of duration you're getting. I was a testaholic. I like data. If you look over Gabby's spreadsheet you'll get a sense of her trends. Also, remember that nadirs can and do move around. It's not a fixed point it's more of a where the numbers fall most of the time.

Some of the differences between the dosing methods:
  • reductions are at 90 (not 40)
  • you do not need to test as aggressively. With TR, the expectation is your pre-shot tests and a minimum of one test per cycle. Most people test a lot more. With SLGS, the minimum is the same. You will want to run a curve every 7 days to evaluate the dose.
  • with TR, you evaluate whether to increase every 3 days (vs every 7 days with SLGS)
Of the top of my head, those are the major differences.

We all make sacrifices to manage our cat's diabetes. I had a couple of occasions when I cancelled plans because I needed to be home to monitor. I also had great friends who were cat people and were fine with making a stop if I wanted to run home and get a quick test. There were times that I needed to travel. I had a pet sitter both in Chicago and in Columbus who I trust implicitly. You do need someone you can rely on if you have to or want be out of the house and to not resent having a diabetic cat. It's a balancing act.
Click to expand...


Should I have been doing curves with TR because I never do.
I don’t mind the testing, she lets me, I just know it hurts her. I mean it can’t be something she enjoys, so I feel bad. She like quints her eyes and sometimes cries a little when I do. The Relion meter takes too much blood so sometimes I don’t get enough from the first poke and I have to do it again and I can tell that makes her uncomfortable. I also worry about the scarring of her ears from testing. These are the only reasons I don’t unless I just simply can not because I am not home. I can feel some scar tissue on her ears too from all the testing.
sometimes I think about getting the libre but I wonder if that will also stress her out…
I think she holds her stress in (probably like most animals) and it comes out in other ways like not getting better, or continuing to get or be sick. There are times I could get one more test but don’t because I don’t want to disrupt the comfy position she’s in or she seems so relaxed I don’t want to disturb her.
 
I mentioned SLGS as an option for you, because I had the sense that you get quite nervous when numbers start to trend down and into under 100 territory. With TR you have to be prepared to have many cycles where that is a regular occurrence, not just a once in a while thing. With SLGS you'll often find that the curves run higher, since as Sienne pointed out, you'd reduce if you get a number under 90.

You mentioned feeding LC at +3 and +3.5, what did you feed? Since numbers were on the rise by +6, I usually would suggest not feeding again, since feeding after nadir can put the brakes on duration.

That said, I'm out of my depth with feeding raw, since I've never done that, but perhaps Katherine @PerfumedCatMom will be by, she feeds raw to her cats.
 
Raw food is great for diabetic kitties. If you're still feeding the Vital Essentials frozen raw, their formulas are complete and balanced so it has everything that Mimi needs and nothing she doesn't need like carbs. What do you have on hand for medium and high carb food in case her numbers go low?
 
PerfumedCatMom said:
Raw food is great for diabetic kitties. If you're still feeding the Vital Essentials frozen raw, their formulas are complete and balanced so it has everything that Mimi needs and nothing she doesn't need like carbs. What do you have on hand for medium and high carb food in case her numbers go low?
Click to expand...
I have FF HC or LC.
I know their poop has no smell and other than diabetes they seem healthy- well the other cat who is 11 acts like a kitten still.
 
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