Newbie in need of feeding and dosing advice

[Cheryl and Monster]

Hello, my Monster is a long time diabetic. He does not like very many wet foods, especially those that are low carb. I can get him to eat a little Weruva (Lamburgini). He does. not like Fancy Feast or Friskies and chicken/turkey. I feed a spoonful of wet when he gets dry and give Dr. Elsy's salmon. I have started adding some water to the dry food. He seem to on several occasions have larger drops in BG when I feed and give the shot, so then he will drop quickly and bounces. I can't get his numbers down. I fear that I should give an increase which will mean he will start dropping quickly. I need help as I find this all very overwhelming and feel helpless in getting him regulated. https://docs.google.com/spreadsheets/d/1WpfTfwbgYrIqe6ZSav9uUXvdaoaXgLqIvMxJx60M-eQ/edit?usp=sharing.

Any help would be appreciated.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

Thank you for getting so many of the initial details taken care of (i.e., a spreadsheet and signature). That helps a great deal.

From looking at Monster's spreadsheet, one thing that I noticed is that you don't seem to be following a dosing strategy. This is a link to a post that outlines the dosing methods we use for Lantus. One of the differences between Lantus and most other types of insulin is that the dose needs several cycles to stabilize. If you make back to back changes in dose, it can give you weird numbers. With the approaches we use, generally the longest a dose is held is a week and then you evaluate the dose to determine if numbers are where you want them. Since your kitty is convinced that dry food is the only thing palatable, you'd need to follow the Start Low Go Slow (SLGS) method for dosing.

This will also likely sound frightening but with Lantus, you can actually shoot lower numbers. I would routinely shoot anything above 50. I would be home to monitor but often, with Lantus, shooting lower numbers yields a flat cycle.

I think you're right that Monster is bouncing. I also suspect he's not used to spending time in lower numbers. If a cat hasn't acclimated to being back in lower numbers (broadly defined), his body treats the higher range as his new normal. As a result, it takes longer to overcome this state.

I'd suggest reading over the information about SLGS. I know you're concerned about increasing the dose. One aspect of SLGS is that doses are reduced if numbers drop below 90. Hopefully, having a set of guidelines will make this easier for both you and Monster.

 

[Cheryl and Monster]

Thank you for your quick response. I believe I should be increasing every 3-4 days if required. Based on the way he bounces.....when do you think I should give his second feeding. He is all over the map, so I will need a lot of help.

 

[Cheryl and Monster]

Welcome to FDMB!

Thank you for getting so many of the initial details taken care of (i.e., a spreadsheet and signature). That helps a great deal.

From looking at Monster's spreadsheet, one thing that I noticed is that you don't seem to be following a dosing strategy. This is a link to a post that outlines the dosing methods we use for Lantus. One of the differences between Lantus and most other types of insulin is that the dose needs several cycles to stabilize. If you make back to back changes in dose, it can give you weird numbers. With the approaches we use, generally the longest a dose is held is a week and then you evaluate the dose to determine if numbers are where you want them. Since your kitty is convinced that dry food is the only thing palatable, you'd need to follow the Start Low Go Slow (SLGS) method for dosing.

This will also likely sound frightening but with Lantus, you can actually shoot lower numbers. I would routinely shoot anything above 50. I would be home to monitor but often, with Lantus, shooting lower numbers yields a flat cycle.

I think you're right that Monster is bouncing. I also suspect he's not used to spending time in lower numbers. If a cat hasn't acclimated to being back in lower numbers (broadly defined), his body treats the higher range as his new normal. As a result, it takes longer to overcome this state.

I'd suggest reading over the information about SLGS. I know you're concerned about increasing the dose. One aspect of SLGS is that doses are reduced if numbers drop below 90. Hopefully, having a set of guidelines will make this easier for both you and Monster.

 

[Cheryl and Monster]

I have read it over. I am asking for some help based on experience of people with the best time to feed the second meal.

 

[Bron and Sheba (GA)]

With SLGS you increase the dose every 7 days if needed.
It is better to follow a dosing method than just increasing when you think it is needed.
The only way to stop or reduce the bouncing is to keep increasing safely as per the dosing method and he will eventually get used to the lower BG numbers. At the moment he is panicking when he finds himself in the lower numbers which really are not low numbers but are lower than he is used to. Does that make sense?
When you say when should you feed a second meal…do you meal a snack?
You feed the 2 main meals before giving the insulin and the. You can feed a couple of snacks preferably during the first half of the cycles. You could try +3 and +5 and see how he goes with that.

 

[Ale & Bobo & Minnie (GA)]

If you’re only feeding twice a day, that’s not ideal. It works for dogs who have a slower metabolism than cats. It’s easier on their pancreas to eat smaller meals throughout the day and it also helps avoid big sugar spikes. As Bron said, most of us feed the 2 larger meals right before giving insulin and 2-3 more snacks or smaller portions of the same food. It’s also a good idea to leave out a snack for him overnight.

 

[Cheryl and Monster]

With SLGS you increase the dose every 7 days if needed.
It is better to follow a dosing method than just increasing when you think it is needed.
The only way to stop or reduce the bouncing is to keep increasing safely as per the dosing method and he will eventually get used to the lower BG numbers. At the moment he is panicking when he finds himself in the lower numbers which really are not low numbers but are lower than he is used to. Does that make sense?
When you say when should you feed a second meal…do you meal a snack?
You feed the 2 main meals before giving the insulin and the. You can feed a couple of snacks preferably during the first half of the cycles. You could try +3 and +5 and see how he goes with that.

Thank you. Previously I was advised to increase if applicable every 4-6 cycles. I will leave it for week unless it drops below 5. I was also told because my cat is a longer diabetic he would not earn a reduction unless he dropped below 5 3 times or below 2.8.

 

[Cheryl and Monster]

If you’re only feeding twice a day, that’s not ideal. It works for dogs who have a slower metabolism than cats. It’s easier on their pancreas to eat smaller meals throughout the day and it also helps avoid big sugar spikes. As Bron said, most of us feed the 2 larger meals right before giving insulin and 2-3 more snacks or smaller portions of the same food. It’s also a good idea to leave out a snack for him overnight.

Thank you

 

[Cheryl and Monster]

Thank you. Previously I was advised to increase if applicable every 4-6 cycles. I will leave it for week unless it drops below 5. I was also told because my cat is a longer diabetic he would not earn a reduction unless he dropped below 5 3 times or below 2.8.

 

[Bron and Sheba (GA)]

Thank you. Previously I was advised to increase if applicable every 4-6 cycles. I will leave it for week unless it drops below 5. I was also told because my cat is a longer diabetic he would not earn a reduction unless he dropped below 5 3 times or below 2.8.

I think you are getting the 2 dosing methods mixed up here.
We don’t increase after 4 cycles with either method.
With tight regulation (TR) you can increase after 6 cycles if the BGs tell you it is needed. With a long term kitty you reduce if the BG drops under 50 (2.8) 3 times. You need to be testing at least 4 times a day (the 2 preshots and once each cycle) and you can’t be feeding any dry food.
With SLGS you can increase after 7 days if needed and doing a curve. You reduce the dose if the BG falls under 90 every time.
You can feed dry with this method. We recommend you test before every shot and again during the cycle is possible.

 

[Cheryl and Monster]

I think you are getting the 2 dosing methods mixed up here.
We don’t increase after 4 cycles with either method.
With tight regulation (TR) you can increase after 6 cycles if the BGs tell you it is needed. With a long term kitty you reduce if the BG drops under 50 (2.8) 3 times. You need to be testing at least 4 times a day (the 2 preshots and once each cycle) and you can’t be feeding any dry food.
With SLGS you can increase after 7 days if needed and doing a curve. You reduce the dose if the BG falls under 90 every time.
You can feed dry with this method. We recommend you test before every shot and again during the cycle is possible.

There is a good chance the person giving advice forgot I was doing the SLGS method. My cat dropped below 5 two cycles ago. Is it too late to give the reduction or should I reduce in the morning?

 

[Bron and Sheba (GA)]

There is a good chance the person giving advice forgot I was doing the SLGS method. My cat dropped below 5 two cycles ago. Is it too late to give the reduction or should I reduce in the morning?

I can’t see where he dropped under 5 two cycles ago.

 

[Cheryl and Monster]

I can’t see where he dropped under 5 two cycles ago.

I have updated the spreadsheet. He bounced big time after.

 

[tiffmaxee]

He’s earned a decrease to 4.0 especially with that 67. Being a long term diabetic you could take reductions with a slower BG than 90, perhaps if under 70. What do you think?

 

[Bron and Sheba (GA)]

I have updated the spreadsheet. He bounced big time after.

Yes you need to reduce the dose after that drop to 3.7 (67) back to 4 Units.
What we can do because he is a long term kitty is we can reduce the reduction BG down to say 80 instead of 90. This is advice for Monster only...DO NOT COPY.
If you decide to do this, you need to put 'Custom dosing- reduction BG 80. ' into your signature and SS please.

EDIT. Oh I see Elise has just posted and has suggested 70, not 80. I am fine with that to.

 

[tiffmaxee]

I’m fine with either 80 or 70.. Whichever you decide once he’s more used to better numbers we can evaluate again.

 

[Cheryl and Monster]

Yes you need to reduce the dose after that drop to 3.7 (67) back to 4 Units.
What we can do because he is a long term kitty is we can reduce the reduction BG down to say 80 instead of 90. This is advice for Monster only...DO NOT COPY.
If you decide to do this, you need to put 'Custom dosing- reduction BG 80. ' into your signature and SS please.

EDIT. Oh I see Elise has just posted and has suggested 70, not 80. I am fine with that to.

Thank you so much. He is all over the map which really stresses me out. He started having really drastic drops when I gave insulin. Now he is going up all day in the morning and it is not a fur shot.

 

[Cheryl and Monster]

He’s earned a decrease to 4.0 especially with that 67. Being a long term diabetic you could take reductions with a slower BG than 90, perhaps if under 70. What do you think?

Thank you so much. He is all over the map which really stresses me out. He started having really drastic drops when I gave insulin. Now he is going up all day in the morning and it is not a fur shot. I have also changed my signature

 

[Bron and Sheba (GA)]

I think you are seeing Monster bouncing from the green BGs a couple of days ago.
Here is an explanation of bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Would you like to start posting over on the LLBpage where everyone uses a depot insulin and you will have more eyes on you.
I will tag @tiffmaxee and @Bandit's Mom to let them know you will be heading over there.
HERE are the posting guidelines for posting on the LLB PAGE

 

[Cheryl and Monster]

I think you are seeing Monster bouncing from the green BGs a couple of days ago.
Here is an explanation of bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Would you like to start posting over on the LLBpage where everyone uses a depot insulin and you will have more eyes on you.
I will tag @tiffmaxee and @Bandit's Mom to let them know you will be heading over there.
HERE are the posting guidelines for posting on the LLB PAGE

Thank you. I know people aren’t suppose to give advice, but I am in desperate need of guidance to get things in a more positive direction.

 

[tiffmaxee]

Thank you. I know people aren’t suppose to give advice, but I am in desperate need of guidance to get things in a more positive direction.

We can give advice based upon our methods.

 

[Bron and Sheba (GA)]

Thank you. I know people aren’t suppose to give advice, but I am in desperate need of guidance to get things in a more positive direction.

It is the fb page that is not supposed to give dosing advice. We can do so here as long as you have spreadsheet data.

 

[Cheryl and Monster]

I think you are seeing Monster bouncing from the green BGs a couple of days ago.
Here is an explanation of bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Would you like to start posting over on the LLBpage where everyone uses a depot insulin and you will have more eyes on you.
I will tag @tiffmaxee and @Bandit's Mom to let them know you will be heading over there.
HERE are the posting guidelines for posting on the LLB PAGE

Hello, I apologize is, trying to figure out how to post there. Please take a look at the spreadsheet. Monster drops so quickly. It scares me too death.

 

[Bron and Sheba (GA)]

Hi Cheryl,
With the drop under 90, Monster has earned a reduction in dose down to 3.75 units.
With SLGS anytime he drops under 90, you need to reduce the dose by 0.25 Units
Are you giving snacks during the first half of the cycle as well a the 2 main meals?
He is looking good! You need to aim for blue and green BGs. I know they can be scary in the beginning but you will learn to love them!

 

[Cheryl and Monster]

Hi Cheryl,
With the drop under 90, Monster has earned a reduction in dose down to 3.75 units.
With SLGS anytime he drops under 90, you need to reduce the dose by 0.25 Units
Are you giving snacks during the first half of the cycle as well a the 2 main meals?
He is looking good! You need to aim for blue and green BGs. I know they can be scary in the beginning but you will learn to love them!

Hi Bron, we are looking at only giving a reduction for under 70. The thing that scares me. Is he drops so quickly. What if this happens when I have to go into the office. He gets 2 main meals. When I work from home, snacks at +3 and +5. I leave food in a micro chip feeder to cover the two snacks while I am at work. He likely gobbles between +1 and +3. At night snacks at +2 and +3…that’s when I go to bed.

 

[Bron and Sheba (GA)]

Hi Bron, we are looking at only giving a reduction for under 70. The thing that scares me. Is he drops so quickly. What if this happens when I have to go into the office. He gets 2 main meals. When I work from home, snacks at +3 and +5. I leave food in a micro chip feeder to cover the two snacks while I am at work. He likely gobbles between +1 and +3. At night snacks at +2 and +3…that’s when I go to bed.

Of course! Sorry!
How many snacks can you give in the feeder?
And when do you leave for work? +1?

 

[Cheryl and Monster]

I have more than one cat so I can’t use the timed feeders. He can eat whenever he wants. I leave for work at +1

 

[Bron and Sheba (GA)]

I have more than one cat so I can’t use the timed feeders. He can eat whenever he wants. I leave for work at +1

Do you leave out dry food for all the cats? Is it enough for all day while you are not there?
If you are concerned about him dropping low while you are away, you could give him a snack at+1 before you leave for work.

 

[Cheryl and Monster]

Do you leave out dry food for all the cats? Is it enough for all day while you are not there?
If you are concerned about him dropping low while you are away, you could give him a snack at+1 before you leave for work.

I leave food for the 2 snacks but he eats it all up at once. He doesn’t leave anything for later lol. He is the only one that can access his feeder.

 

[Bron and Sheba (GA)]

Some kitties are like that and eat it all at once! what about a timed get where it opens when you want it to?

 

[Cheryl and Monster]

Some kitties are like that and eat it all at once! what about a timed get where it opens when you want it to?

I have 2 cats and the other one will push him out of the way. It stresses them out too much to leave them in separate rooms.

 

[Cheryl and Monster]

I think you are seeing Monster bouncing from the green BGs a couple of days ago.
Here is an explanation of bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Would you like to start posting over on the LLBpage where everyone uses a depot insulin and you will have more eyes on you.
I will tag @tiffmaxee and @Bandit's Mom to let them know you will be heading over there.
HERE are the posting guidelines for posting on the LLB PAGE

Thank you…I finally posted. This forum is all new to me.

 

[Bron and Sheba (GA)]

Keep asking questions

 

[Cheryl and Monster]

Keep asking questions

I feel so defeated.

 

[Bron and Sheba (GA)]

I feel so defeated.

Don't feel defeated I know how frustrating it can be. If he was diagnosed in 2018 you are obviously looking after him very well.
When you get a drop like you did on 17/7 in the pm cycle from 288 at PMPS to 227@+2 that is a red flag to say he is most likely going to keep dropping and the higher numbers you are seeing today could be from a bounce.
Are you giving snacks in the early parts of the cycle?
Is he well apart from giving you some high numbers?
Eating well?

 

[Cheryl and Monster]

Don't feel defeated I know how frustrating it can be. If he was diagnosed in 2018 you are obviously looking after him very well.
When you get a drop like you did on 17/7 in the pm cycle from 288 at PMPS to 227@+2 that is a red flag to say he is most likely going to keep dropping and the higher numbers you are seeing today could be from a bounce.
Are you giving snacks in the early parts of the cycle?
Is he well apart from giving you some high numbers?
Eating well?

He gets snacks at +3 and plus 5 in the am and +2 and +3 at nigh…bedtime. He is starting to be even more social and is willing to entertain minimal play from no play lol
He seems to want to drop low sometimes with insulin…then he takes a turn for the worse

 

[Bron and Sheba (GA)]

then he takes a turn for the worse

What happens?

 

[Cheryl and Monster]

Don't feel defeated I know how frustrating it can be. If he was diagnosed in 2018 you are obviously looking after him very well.
When you get a drop like you did on 17/7 in the pm cycle from 288 at PMPS to 227@+2 that is a red flag to say he is most likely going to keep dropping and the higher numbers you are seeing today could be from a bounce.
Are you giving snacks in the early parts of the cycle?
Is he well apart from giving you some high numbers?
Eating well?

Ohh spend he lives his dinner. He will not eat more than a couple tablespoons of low carb wet food a day…I usually add something to entice him like crumbled Adrian. Elsy’s.

 

[Cheryl and Monster]

What happens?

The really high numbers

 

[Bron and Sheba (GA)]

The really high numbers

Do they make him feel unwell?
I would offer him more fluids when he is in high numbers
I used to worry about Sheba in high numbers. I remember one day my sister came to visit me and all I talked bout was Sheba and her high numbers.

 

[Cheryl and Monster]

Do they make him feel unwell?
I would offer him more fluids when he is in high numbers
I used to worry about Sheba in high numbers. I remember one day my sister came to visit me and all I talked bout was Sheba and her high numbers.

Great idea about the fluids.
Check out the drops from last nigh….this is what totally stresses me…he can drop so quickly.
I can completely relate about your visit with your sister.

 

[Cheryl and Monster]

Great idea about the fluids.
Check out the drops from last nigh….this is what totally stresses me…he can drop so quickly.
I can completely relate about your visit with your sister.

I posted on the Lantus forum a few hours ago. Can you take a look?

 

[Cheryl and Monster]

Great idea about the fluids.
Check out the drops from last nigh….this is what totally stresses me…he can drop so quickly.
I can completely relate about your visit with your sister.

have definitely had an interesting couple days. I really hope he can get use to good numbers.