NEW MEMBER NEED ADVICE - The first BG results of my diagnosed cat Kosmo! - What do you think?

[Kobe (Dean and Lesley) MO]

I appreciate you giving it a try. If we could get the as-feds or the DMB and not the GAs, we could use the method in my post but I also have a quick and easy calculator for it

I emailed them asking for either the GA or the DMB Values. Hopefully we hear back, we put the numbers in your quick and easy calculator, and we get to the bottom of this!!!

 

[Marje and Gracie]

I emailed them asking for either the GA or the DMB Values. Hopefully we hear back, we put the numbers in your quick and easy calculator, and we get to the bottom of this!!!

Thank you but you want “as-feds” or DMB, not GAs Maybe just a typo?

 

[Kobe (Dean and Lesley) MO]

Thank you but you want “as-feds” or DMB, not GAs Maybe just a typo?

Unfortunately, it wasn't a typo! I legitimately made that mistake AGAIN and emailed them asking for the WRONG THING. My poor brain is not braining. UGH.

I emailed again. We'll see.

 

[Marje and Gracie]

Unfortunately, it wasn't a typo! I legitimately made that mistake AGAIN and emailed them asking for the WRONG THING. My poor brain is not braining. UGH.

I emailed again. We'll see.

It’s ok….it happens to all of us. FD exhaustion makes it easy for those things to occur. I hope you hear from them.

 

[Diane Tyler's Mom GA]

And I am from the netherlands!

Can you please add Netherlands to your signature
Tap on your name up top then tap on signature add it then tap save
@Kosmo

 

[Diane Tyler's Mom GA]

Thank you. I saw when he posted he was switching. Please be aware that advising members to just change the ranges and the title is incorrect. I have to change the formatting or else it’s still going to be recording in pet meter ranges. This could endanger the cat and confuse the CG. Thanks, Diane.

Sorry Marje I didn't know , in the future if someone switches to a human meter or pet meter I will let you know
@Marje and Gracie

 

[Marje and Gracie]

Can you please add Netherlands to your signature
Tap on your name up top then tap on signature add it then tap save
@Kosmo

Not necessary.

 

[Marje and Gracie]

Sorry Marje I didn't know , in the future if someone switches to a human meter or pet meter I will let you know
@Marje and Gracie

Thank you.

 

[Kobe (Dean and Lesley) MO]

It’s ok….it happens to all of us. FD exhaustion makes it easy for those things to occur. I hope you hear from them.

I heard back from Royal Canin, but they gave me information about an US product, not the one Kosmo is eating. They probably saw my US based email and decided to give me what they thought I wanted instead of what I really asked for (the second time when I did it right). Maybe someone on the European side of the pond could give it a shot?

 

[Marje and Gracie]

I heard back from Royal Canin, but they gave me information about an US product, not the one Kosmo is eating. They probably saw my US based email and decided to give me what they thought I wanted instead of what I really asked for (the second time when I did it right). Maybe someone on the European side of the pond could give it a shot?

Really appreciate your efforts. I’m not sure who all is in Europe at this time. However, I wouldn’t spend too much more time on it as Kosmo’s dad is changing his food. Thank you so much, though.

 

[Kobe (Dean and Lesley) MO]

Those are guaranteed analysis and can’t be used to accurately determine % calories from carbs. Thank you but that is not typically how we calculate % calories from carbs.

I believe that I understand my mistakes from yesterday. Will you tell me if this is right so that I don't continue to speak about this incorrectly?

When we say, "5% carbs," what we really mean is "5% of the food's calories are from carbs." Which is very different than saying that "5% of the food's mass is from carbs," because the different macronutrients vary in calories per gram. In my little calculation yesterday, I found the % of carbohydrates for the dry mass, which is not what we wanted at all.

To top it off, I used the GA values instead of the "as-feds" or DMB values. The GA values being minimum and maximum possible values instead of exact values.

Eg. I have no more than $20 in my purse vs I have exactly $17 in my purse.

 

[Kobe (Dean and Lesley) MO]

Really appreciate your efforts. I’m not sure who all is in Europe at this time. However, I wouldn’t spend too much more time on it as Kosmo’s dad is changing his food. Thank you so much, though.

Thanks, Marje.

 

[Marje and Gracie]

I believe that I understand my mistakes from yesterday. Will you tell me if this is right so that I don't continue to speak about this incorrectly?

When we say, "5% carbs," what we really mean is "5% of the food's calories are from carbs." Which is very different than saying that "5% of the food's mass is from carbs," because the different macronutrients vary in calories per gram. In my little calculation yesterday, I found the % of carbohydrates for the dry mass, which is not what we wanted at all.

To top it off, I used the GA values instead of the "as-feds" or DMB values. The GA values being minimum and maximum possible values instead of exact values.

Eg. I have no more than $20 in my purse vs I have exactly $17 in my purse.

Correct. What we are always looking at is the % calories from carbs. Yes, the macros do vary in calories per gram with protein and carbs being 3.5 cal/gr and fat being 8.5 cal/gr.

If you’ve had time to read my post I linked, it explains it in more detail.

GAs can’t be used (although there are some formulas which try) because the values are just guaranteed to have a maximum or minimum of a macro but the actual amount can vary to a good degree.

Thanks again!

 

[Kosmo]

@Marje and Gracie

Could you explain something to me please?

My logic seems to struggle with understanding this.

Let’s say I give my cat 2 units of Lantus when his AMPS (morning pre-shot blood glucose) is 25 mmol/L (250 mg/dL),
And about 7–8 hours later, his blood glucose drops to a nadir of 12.9 mmol/L (232.2 mg/dL).

Now, let’s assume his blood glucose stays around that level until the evening shot (PMPS), and I give him another 2 units of Lantus.

What I don’t understand is this: if the previous 2-unit dose already lowered his glucose from 25 mmol/L (250 mg/dL) to 12.9 mmol/L (232.2 mg/dL), wouldn’t giving another 2 units now—when his blood glucose is already at 12.9 mmol/L (232.2 mg/dL) —push it even lower, possibly to dangerous levels?

The reason to that is because the lantus left his system right?

And my most important question:
And what if a AMPS shot of Lantus brings my cat's blood glucose down from 25 mmol/L (450 mg/dL) to 12.9 mmol/L (232.2 mg/dL), but then it goes right back up to 25 mmol/L (232.2 mg/dL) again before the next PMPS shot (Which happens everytime to my cat) how is it ever supposed to reach and stay in average healthy ranges throughout the day if it keeps jumping back up to the previous levels?

 

[Kobe (Dean and Lesley) MO]

This might help you to picture what is happening.

Because of the duration of Lantus, the effects of the shots overlap. As the effect of one shot is waning, the next is ramping up to take its place. This makes the BG curve for Lantus pretty flat (usually). The cat's lowest BG generally corresponds with the peak action of the insulin. Higher BG tends to occur as the new shot takes over for the previous shot.

Every cat is different, some cats get earlier nadirs around 4 hours after shot. For others it's 6 or 8 hours after shot. This is one more reason why the data you put in your spreadsheet is so important; we'll be able to identify how each dose affects your kitty .

 

[Kobe (Dean and Lesley) MO]

What I don’t understand is this: if the previous 2-unit dose already lowered his glucose from 25 mmol/L (250 mg/dL) to 12.9 mmol/L (232.2 mg/dL), wouldn’t giving another 2 units now—when his blood glucose is already at 12.9 mmol/L (232.2 mg/dL) —push it even lower, possibly to dangerous levels?

The reason to that is because the lantus left his system right?

The last shot, altough not totally done, is leaving his system and we want the new shot ready to take over!

 

[Kosmo]

This might help you to picture what is happening.

View attachment 73351

Because of the duration of Lantus, the effects of the shots overlap. As the effect of one shot is waning, the next is ramping up to take its place. This makes the BG curve for Lantus pretty flat (usually). The cat's lowest BG generally corresponds with the peak action of the insulin. Higher BG tends to occur as the new shot takes over for the previous shot.

Every cat is different, some cats get earlier nadirs around 4 hours after shot. For others it's 6 or 8 hours after shot. This is one more reason why the data you put in your spreadsheet is so important; we'll be able to identify how each dose affects your kitty .

Thank you for taking the time to respond.

I understand now.

But for my last thing that I mentioned I still do not understand.

Lets say that I know the amount of lantus iu to get my cat to perfect levels of BG when the Nadir occurs, and this takes for example 8 hours after the shot to reach, but in the time leading up to this perfect BG levels, the cat still experiences very unhealthy BG levels before he gets to the safe BG levels.

So what I want to know is:
Is it even possible to get my cats BG levels to reach the safe BG range throughout the day that is steady, or is the best I can hope for he only has a few hours of Nadir safe BG levels?

In other words will the lantus treatment only make him healthy for 4/8 hours (being in healthy BG levels) of the 24 hours of a day?

 

[Kobe (Dean and Lesley) MO]

And my most important question:
And what if a AMPS shot of Lantus brings my cat's blood glucose down from 25 mmol/L (450 mg/dL) to 12.9 mmol/L (232.2 mg/dL), but then it goes right back up to 25 mmol/L (232.2 mg/dL) again before the next PMPS shot (Which happens everytime to my cat) how is it ever supposed to reach and stay in average healthy ranges throughout the day if it keeps jumping back up to the previous levels?

That's where your dosing protocol is important (I see you picked Tight Regulation ). Based on your cat's nadir/ lowest BG, the dosing protocol determines whether to hold the current dose (because it's giving your cat the correct amount of insulin), increase the dose (because your cat needs more insulin to bring BG down to healthy, healing levels), or decrease the dose (because your cat's body is requiring less insulin to stay in the desired BG range). The members on this forum will help you make these decisions so that your cat stays safe. And they will use all the data you collect to do it!

 

[Kosmo]

That's where your dosing protocol is important (I see you picked Tight Regulation ). Based on your cat's nadir/ lowest BG, the dosing protocol determines whether to hold the current dose (because it's giving your cat the correct amount of insulin), increase the dose (because your cat needs more insulin to bring BG down to healthy, healing levels), or decrease the dose (because your cat's body is requiring less insulin to stay in the desired BG range). The members on this forum will help you make these decisions so that your cat stays safe. And they will use all the data you collect to do it!

Thank you for responding and being so helpfull.

I almost do understand everything about how it works but I would like to know more specific details that I can not find online.

Can you check my comment above?

I would like to know if it is possible to keep him 24/7 in healthy BG ranges with lantus and tight regulation.

Or is he doomed and will experience huge unhealthy BG levels fluctuations even if I give him the best treatment.

 

[Tim & Pookey]

I would like to know if it is possible to keep him 24/7 in healthy BG ranges with lantus and tight regulation.

Or is he doomed and will experience huge unhealthy BG levels fluctuations even if I give him the best treatment.

Absolutely possible! Look at Kobe’s spreadsheet from Lesley’s responses above. He’s one of many great examples of numbers improving over time with the proper treatment.

 

[Kosmo]

Absolutely possible! Look at Kobe’s spreadsheet from Lesley’s responses above. He’s one of many great examples of numbers improving over time with the proper treatment.

Thank you for your response.

I have looked at it but I can not switch with the tabs below to see the data in mmol/s and I am from the Netherlands with different metrics so I do not understand this data.

 

[Kobe (Dean and Lesley) MO]

But for my last thing that I mentioned I still do not understand.

Lets say that I know the amount of lantus iu to get my cat to perfect levels of BG when the Nadir occurs, and this takes for example 8 hours after the shot to reach, but in the time leading up to this perfect BG levels, the cat still experiences very unhealthy BG levels before he gets to the safe BG levels.

So what I want to know is:
Is it even possible to get my cats BG levels to reach the safe BG range throughout the day that is steady, or is the best I can hope for he only has a few hours of Nadir safe BG levels?

In other words will the lantus treatment only make him healthy for 4/8 hours (being in healthy BG levels) of the 24 hours of a day?

This will vary by cat. I found it very helpful to look at the spreadsheets of the other cats whose humans post on the Lantus forum. What I saw happening is that kitties generally start to spend more and more time in the desired range. As they spend more time in the desired range they become regulated. This happens quickly for some and more slowly for others. We just have to be patient.

 

[Tim & Pookey]

Thank you for your response.

I have looked at it but I can not switch with the tabs below to see the data in mmol/s and I am from the Netherlands with different metrics so I do not understand this data.

I’m going to feel like a jerk if you’re colorblind… but the colors tell enough of the story anyways! Green and blue are healing.

 

[Kosmo]

I’m going to feel like a jerk if you’re colorblind… but the colors tell enough of the story anyways! Green and blue are healing.

Haha of course not. But I see yes.

I will learn the dg/dl metrics today so that I understand both I guess.

 

[Marje and Gracie]

@Marje and Gracie

Could you explain something to me please?

My logic seems to struggle with understanding this.

Let’s say I give my cat 2 units of Lantus when his AMPS (morning pre-shot blood glucose) is 25 mmol/L (250 mg/dL),
And about 7–8 hours later, his blood glucose drops to a nadir of 12.9 mmol/L (232.2 mg/dL).

Now, let’s assume his blood glucose stays around that level until the evening shot (PMPS), and I give him another 2 units of Lantus.

What I don’t understand is this: if the previous 2-unit dose already lowered his glucose from 25 mmol/L (250 mg/dL) to 12.9 mmol/L (232.2 mg/dL), wouldn’t giving another 2 units now—when his blood glucose is already at 12.9 mmol/L (232.2 mg/dL) —push it even lower, possibly to dangerous levels?

The reason to that is because the lantus left his system right?

And my most important question:
And what if a AMPS shot of Lantus brings my cat's blood glucose down from 25 mmol/L (450 mg/dL) to 12.9 mmol/L (232.2 mg/dL), but then it goes right back up to 25 mmol/L (232.2 mg/dL) again before the next PMPS shot (Which happens everytime to my cat) how is it ever supposed to reach and stay in average healthy ranges throughout the day if it keeps jumping back up to the previous levels?

Adding to the explanation by Lesley, as the pancreas heals with insulin support and the BG comes down, the drops are typically smaller and, as Lesley said, the curve flatter.

To answer your second question, if Kosmo continues with those high BGs, then we increase the dose. After the initial ten cycles, our dose increases, if necessary, come after six cycles unless the BG continues to stay high (above 300) at which time we can increase after four cycles or increase by 0.5u. If following the protocol and taking increases when required, the overall BG range should decrease.