7/26 Moonie AMPS 239, +2 239, +9 139, PMPS 138, +2 134

[Connie & Parker & Moonie]

7/23 Moonie AMPS 130, +1.5 105, +3 96, +4 104, PMPS 87, +2 162, +3 142

Hi everyone - sorry we’ve been missing for a couple days. It’s been a tough stretch.

We decided to lower Moonie’s dose last night to 2.75u. It’s something that Parker has been advocating for a long time based on some studies he’s read (that I won’t do justice to so I won’t link here / let him make his own case). I think the crux of the papers is that an excessively high dose can cause rapid drops that perpetuate bounce cycles, whereas a lower dose would flatten out the curve because it won’t have the downward momentum to cause those kinds of drops in the first place.

I don’t agree and we’ve been disagreeing for a while. I generally don’t put a lot of trust in academic papers or institutions, and to me, it seems like if a dose reduction worked as a reset, it would be reflected in the collective experience of caregivers here by now. I also think that we had significantly better numbers and curve shape on 3.25u vs. 3u so I’m not sure why a reduction would help.

However I admit that part of my resistance might be that if this were right, I’d have to admit that my monitoring at night has been imperfect. That maybe she has been going into unsafe numbers (or fast drops) late at night that I haven’t caught - and that’s what’s been contributing to these bounces. 7/16 pm and 7/23pm are both examples where I know this happened. I think “too much insulin looking like not enough insulin” is probably more for new caregivers who aren’t testing enough and started with too high of a dose, but maybe it’s just something I’m telling myself to feel good about my own caregiving.

Anyway it’s a long winded way to say - 3-4 days of this isn’t going to cause any permanent harm, and I won’t be able to disprove this hypothetical without it playing out. And honestly I would love to be proven wrong and I don’t know with 100 percent certainty it won’t work. So why not at this point?

On top of that, what really tipped me over the edge is that Moonie has started resisting testing. It used to be this fun thing we’d do together where I’d sing and call to her, she’d strut into the testing room, and we’d do treats and an ear massage before poking. She won’t come anymore when called, and she’s started flicking her ear away or moving away when I try to warm her ears. Yesterday she even went behind the bed to avoid me and it broke my heart.

I think she needs a testing break. I can’t guarantee that break with her safety at the 3u dose. So I think it’ll be better for her to have a few days of light testing than for us to continue like this. If it all goes right, we’ll have years and years of testing ahead of us and I can’t afford for her to hate it. Though she has been more irritable with her blood glucose fluctuating so much, so I don’t know how much of this is testing specific.

Sorry this has turned into such a demoralizing little update. But these are all small problems in the grand scheme of things and this is just a moment in time.

On a brighter note here is Miss Moons showing off her magnificent belly!

 

[Staci & Ivy]

Awwww Connie, please be kind to yourself. It’s a process here and we try many different things as things evolve.
You’re doing an incredible job with her care and you should be very proud
And it’s difficult if our partners may not completely agree with our current philosophy or plan.

Sweet Moonie will be fine and she will most likely come around with the testing. If you can back off for a few days and it helps, the long range goal is the key. You have it right.
Love her adorable belly pics, btw
Please hang in there. This is a marathon, not a sprint, as you’ve seen here many times.
One day at a time.
Sending many good wishes for a calm and peaceful day

 

[Connie & Parker & Moonie]

Awwww Connie, please be kind to yourself. It’s a process here and we try many different things as things evolve.
You’re doing an incredible job with her care and you should be very proud
And it’s difficult if our partners may not completely agree with our current philosophy or plan.

Sweet Moonie will be fine and she will most likely come around with the testing. If you can back off for a few days and it helps, the long range goal is the key. You have it right.
Love her adorable belly pics, btw
Please hang in there. This is a marathon, not a sprint, as you’ve seen here many times.
One day at a time.
Sending many good wishes for a calm and peaceful day

Thanks Staci! I think it’s just been a demoralizing stretch with her bounces and everything else going on. Hopefully Moonie comes back around to testing. We used to have a lot of fun with it.

And hopefully this 3-4 day stretch is what we need to give Moonie’s ears a break and me and Parker back on the same page

 

[Tim & Pookey]

Give it a shot! I think it will provide some useful information and yea maybe a little break too. And it’s not like you cut the dose in half, so that’s good.

I think this is one area where this website and some other FD groups disagree. Some groups will recommend a reset dose and drop the dose by a lot. Maybe they saw the same papers. I bet Wendy/Marje have some stories about this.

 

[Connie & Parker & Moonie]

Give it a shot! I think it will provide some useful information and yea maybe a little break too. And it’s not like you cut the dose in half, so that’s good.

I think this is one area where this website and some other FD groups disagree. Some groups will recommend a reset dose and drop the dose by a lot. Maybe they saw the same papers. I bet Wendy/Marje have some stories about this.

Thanks Tim! I think this was the paper that sparked our many discussions.

I figured a couple days at a “vacation dose” won’t do too much harm especially when Moonie seems so sick of testing. And we agreed that we’d reassess after 6 cycles or 2 pink numbers, whichever comes first. And who knows, maybe it’ll work

 

[Elaine and Ember]

Hopefully the little break will do you both good.
I agree that she has a most magnificent belly!

 

[Connie & Parker & Moonie]

Hopefully the little break will do you both good.
I agree that she has a most magnificent belly!

Thank you! She does too, that’s why she loves showing it off

 

[Sara & Khloe]

Moonie must have so much trust and be so comfortable and safe to sleep like that. She looks like she's loving life! That's all you Connie, giving a beautiful kitty a 2nd home and giving her the best life possible! You should be proud of yourself!
Give the little Moon Moon a cuddle sesh from me!

 

[Connie & Parker & Moonie]

Moonie must have so much trust and be so comfortable and safe to sleep like that. She looks like she's loving life! That's all you Connie, giving a beautiful kitty a 2nd home and giving her the best life possible! You should be proud of yourself!
Give the little Moon Moon a cuddle sesh from me!

Thanks Sara you’re very sweet. I will when she’s snoozing next. Moon Moon has arisen as she somehow has a built in clock and is now prowling for food

 

[Wendy&Neko]

I bet Wendy/Marje have some stories about this.

Yup, lots of stories about reset. Then cats doing poorly. There used to be a separate forum here called "Relaxed Lantus" which was like SLGS but even slower. They believed in resets. I remember one poor kitty in pinks got reset to 1 unit, ketones rose, went into DKA. That's the serious downside to resets. The not as serious ones is that you set the cat back, they get glucose toxicity, and it takes forever to get back to numbers you used to see. At one point the mods (Jill and others who predate Marje, Sienne, and me) put their foot down and consolidated the Lantus forums. The people who hung around on Relaxed left and started their FB group where they give continue to give sketchy suggestions.

Having said that, take a kitty back a bit in dose to give yourself a break is OK if you need that break. I did it a few times with Neko when SRT was at it's strongest. For three months straight she got all her reductions in the wee hours, and bounced during the day. I was exhausted and needed sleep. A couple nights of sleep and I was good to go again. Occasionally, due to SRT action, the reduction held.

the crux of the papers is that an excessively high dose can cause rapid drops that perpetuate bounce cycles, whereas a lower dose would flatten out the curve because it won’t have the downward momentum to cause those kinds of drops in the first place.

There are many a time I would have traded your "excessively high dose" of 3 units for Neko's 8.75U. Yes Neko bounced, but that's because she wasn't used to low blues, much less greens. She had IAA (insulin auto antibodies) and wasn't going to get used to greens unless at a higher dose where she kept on seeing them. It took her a year to stop bouncing to reds! A lower dose with flatter but higher curves isn't always desirable. Flatter yellow or flatter high blues don't help the cat get used to normal blood sugar numbers. Moonie's closing in on her two year FDaversary. She probably hadn't seen much green before her time with you. Her body will resist normal blood sugar values cause it isn't used to them.

Having said that, nothing wrong with an experiment. Learn by doing and gathering data. Just don't wait overly long at the lower dose if she stops seeing green.

 

[Connie & Parker & Moonie]

Yup, lots of stories about reset. Then cats doing poorly. There used to be a separate forum here called "Relaxed Lantus" which was like SLGS but even slower. They believed in resets. I remember one poor kitty in pinks got reset to 1 unit, ketones rose, went into DKA. That's the serious downside to resets. The not as serious ones is that you set the cat back, they get glucose toxicity, and it takes forever to get back to numbers you used to see. At one point the mods (Jill and others who predate Marje, Sienne, and me) put their foot down and consolidated the Lantus forums. The people who hung around on Relaxed left and started their FB group where they give continue to give sketchy suggestions.

Having said that, take a kitty back a bit in dose to give yourself a break is OK if you need that break. I did it a few times with Neko when SRT was at it's strongest. For three months straight she got all her reductions in the wee hours, and bounced during the day. I was exhausted and needed sleep. A couple nights of sleep and I was good to go again. Occasionally, due to SRT action, the reduction held.

There are many a time I would have traded your "excessively high dose" of 3 units for Neko's 8.75U. Yes Neko bounced, but that's because she wasn't used to low blues, much less greens. She had IAA (insulin auto antibodies) and wasn't going to get used to greens unless at a higher dose where she kept on seeing them. It took her a year to stop bouncing to reds! A lower dose with flatter but higher curves isn't always desirable. Flatter yellow or flatter high blues don't help the cat get used to normal blood sugar numbers. Moonie's closing in on her two year FDaversary. She probably hadn't seen much green before her time with you. Her body will resist normal blood sugar values cause it isn't used to them.

Having said that, nothing wrong with an experiment. Learn by doing and gathering data. Just don't wait overly long at the lower dose if she stops seeing green.

Thank you so much for this, Wendy! I’m going to show this to Parker tonight.

I did not know that there was such a lore behind the groups. Wow.

We agreed to do this for 6 cycles or 2 pinks, whichever comes first. And I do think Moonie needed a testing break. She was already more cooperative this afternoon after just a day of only 4 tests. So hopefully another day or two like this can help her feel good about the tests again.

The caregivers for acro cats never fail to amaze me. You’re right that 3u is nothing in the grand scheme of things

I don’t think Moonie ever saw a green before we started at FDMB. The very small number of blood glucose tests we got were all in the 300s. And I still remember when we started a single yellow or blue would be enough to cause a bounce. That’s why I try to remind myself to be grateful that for us, yellow and blues are now the numbers Moonie bounces to, not the numbers that trigger the bounce. Hopefully with enough time and exposure, she’ll get used to the greens too the way she did with the yellows and blues.

Can I ask a dumb question? My biggest worry is that because Moonie is bouncing so much, she’s not spending enough time in healing numbers to get used to them. Is that true? In that case, would we consider an increase even if she’s seeing nadirs in 50/60 every 3-4 cycles? I just worry that while the nadirs are good, they’re almost gone in a flash and she’s rarely held the green for more than a couple hours at a time.

Thank you again!

 

[Wendy&Neko]

My biggest worry is that because Moonie is bouncing so much, she’s not spending enough time in healing numbers to get used to them. Is that true? In that case, would we consider an increase even if she’s seeing nadirs in 50/60 every 3-4 cycles? I just worry that while the nadirs are good, they’re almost gone in a flash and she’s rarely held the green for more than a couple hours at a time.

Neko started her green journey one hour at a time. It took a long time before she got more than an hour or two in greens. Looking back at Moonie's recent SS numbers, I see several entire cycles that were green. Those were fantastic. She has the potential. I see only one nadir below 80 since you started the higher carb LC. Give her some time to see where her nadirs are landing with consistent feeding of that food. Then make a decision. If you don't see anything in the 50's or 60's again, then you can threaten that increase.

 

[Connie & Parker & Moonie]

Neko started her green journey one hour at a time. It took a long time before she got more than an hour or two in greens. Looking back at Moonie's recent SS numbers, I see several entire cycles that were green. Those were fantastic. She has the potential. I see only one nadir below 80 since you started the higher carb LC. Give her some time to see where her nadirs are landing with consistent feeding of that food. Then make a decision. If you don't see anything in the 50's or 60's again, then you can threaten that increase.

Thank you so much Wendy! We could always go back to the 0-2% LC for the lower nadir but Moonie just loves the Lamb Burgini so much that I think we’d on net go with a higher dose than take her off it.

I think the hardest part of this journey is the patience pants! Thank you for reminding us to be patient! It didn’t take a month for Moonie to get diabetes, and she was a poorly regulated diabetic kitty for 1.5 years before I met her. So it won’t resolve itself in just a couple months and it’s a good reminder to be grateful for the amazing progress we have seen since we joined FDMB.

 

[Seth&Bell]

I've had similar thoughts in the past and Wendy has always (correctly) reminded me that lowering a non-reduction earning dose won't help prevent bounces. I've seen many here try and most last 2 or 3 days and just want to see those greens again . But doesn't hurt to try a few things and give yourself a break!

I can only speak to Bell, but if you look at her spreadsheet, the most time she spends in greens is when she is close to a reduction. Now I have the opposite problem, I want to hold reduction doses longer to keep her flat, and folks have to steer me away from doing that.

I think that picture of Moonshine tells the tale of how you've been doing! I would trade a lot for Bell's spreadsheet to look like Moonie's but when it comes down to it what matters is how Moonie and Bell are doing.

I'm sorry about her not wanting the pokes, that is tough. Bell started trying to turn her head in the hardest direction for me to poke recently and it is annoying. I'm lucky she is slow and lazy and won't expend the effort to get up and run away.

 

[Mary & Jude]

Thanks Tim! I think this was the paper that sparked our many discussions.

I figured a couple days at a “vacation dose” won’t do too much harm especially when Moonie seems so sick of testing. And we agreed that we’d reassess after 6 cycles or 2 pink numbers, whichever comes first. And who knows, maybe it’ll work

I see an abstract, but I don't see the full text. What am I missing--show me where to click?

 

[Connie & Parker & Moonie]

I see an abstract, but I don't see the full text. What am I missing--show me where to click?

This link should be better!

Glucose concentrations after insulin‐induced hypoglycemia and glycemic variability in healthy and diabetic cats - PMC

 

[Connie & Parker & Moonie]

I've had similar thoughts in the past and Wendy has always (correctly) reminded me that lowering a non-reduction earning dose won't help prevent bounces. I've seen many here try and most last 2 or 3 days and just want to see those greens again . But doesn't hurt to try a few things and give yourself a break!

I can only speak to Bell, but if you look at her spreadsheet, the most time she spends in greens is when she is close to a reduction. Now I have the opposite problem, I want to hold reduction doses longer to keep her flat, and folks have to steer me away from doing that.

I think that picture of Moonshine tells the tale of how you've been doing! I would trade a lot for Bell's spreadsheet to look like Moonie's but when it comes down to it what matters is how Moonie and Bell are doing.

I'm sorry about her not wanting the pokes, that is tough. Bell started trying to turn her head in the hardest direction for me to poke recently and it is annoying. I'm lucky she is slow and lazy and won't expend the effort to get up and run away.

Thanks Seth! Bell is the Queen of Pogo Sticks and I’m always in awe of how well you anticipate her moves.

I agree with you. I think we sometimes let ourselves get bogged down in the minutiae of the numbers and colors and forget that what we’re ultimately trying to give our kitties is the highest quality of life. And that gets reflected in everything from lazy afternoon naps and naughty rug zoomies to playfully stalking toys.

It’s funny because I have the same inclination you do! And Parker always has to steer me away from it. In my mind, if I could just get her back on that 3.25u, maybe she’ll show me some flat greens again even if it means the occasional lime but hey maybe I’ll just stay up all night and professionally watch Moon Moon for a living . I will say for us though her prior 3.25u dose was on 0-2% carb food she didn’t like very much vs. ravenously tearing through 7.5% carb food today. So there is a part of me that wonders if we do end up going back there for some period of time.

I hope Bell can teach her ways of laziness to Moonie. Maybe Blair can help with a spell? To make ear pokes seem really really fun again? I did start numbing her ear with the tiniest dab of Emla cream 30 mins before the poke and that seems to be helping a bit. That or it’s placebo effect for me but it’s making me feel better so

 

[Marje and Gracie]

This link should be better!

Glucose concentrations after insulin‐induced hypoglycemia and glycemic variability in healthy and diabetic cats - PMC

This link should be better!

Glucose concentrations after insulin‐induced hypoglycemia and glycemic variability in healthy and diabetic cats - PMC

As a scientist ( biologist), I find so many issues with this “study”. The sample sizes were small, the “controls” were not well defined, feeding was not consistent, some cats were monitored at home and some at the vet, some of the vet-monitored cats did not have their doses reduced after hypoglycemia, there was not a specific protocol followed, there was some selection bias; I could go on and on and the paper is old and I have not seen anything that shows the results were repeatable which is vitally important before drawing conclusions.

I also have firsthand experience with this. I met with a feline only board-certified internal medicine vet not long after Gracie was diagnosed. She saw the bouncing and told me I was “killing” my cat and she was clearly not diabetic. I posted here and members encouraged me to not stop insulin. As a compromise, I dropped her dose back a bit. Her BG shot up as soon as her depot drained. I took her dose back up.

What happens when you reduce the dose is the bouncing can stop but that’s because the BG becomes high and flat.

I’m glad Wendy told you the history of the Relaxed Lantus forum and their rebound checks. They run a FB group and are still doing the same thing. We have had many members come here because their cats were making no progress.

I agree with Wendy, if you all & Moonie need a break, you should take it. But please don’t let her stay long at a dose that isn’t working. And remember it can take up to six cycles for the depot to drain.

We’ve seen cats who bounced for a couple years and then went OTJ in less than a month. I wanted to link their SSs but they have been gone a while and the CGs deleted their SSs.

We are here to support you all.

 

[Wendy&Neko]

If Moonie loves her Lamb Burgini, let her have the few extra carbs. I've seen a few cats do better with a bit higher carbs. It can allow you to give a little bit more insulin, depending on the carb sensitivity of the cat. A post from the vaults, note conversation uses World numbers:

• Feeding Low Carb vs Lower Carb Foods

 

[Seth&Bell]

Thanks Seth! Bell is the Queen of Pogo Sticks and I’m always in awe of how well you anticipate her moves.

I agree with you. I think we sometimes let ourselves get bogged down in the minutiae of the numbers and colors and forget that what we’re ultimately trying to give our kitties is the highest quality of life. And that gets reflected in everything from lazy afternoon naps and naughty rug zoomies to playfully stalking toys.

It’s funny because I have the same inclination you do! And Parker always has to steer me away from it. In my mind, if I could just get her back on that 3.25u, maybe she’ll show me some flat greens again even if it means the occasional lime but hey maybe I’ll just stay up all night and professionally watch Moon Moon for a living . I will say for us though her prior 3.25u dose was on 0-2% carb food she didn’t like very much vs. ravenously tearing through 7.5% carb food today. So there is a part of me that wonders if we do end up going back there for some period of time.

I hope Bell can teach her ways of laziness to Moonie. Maybe Blair can help with a spell? To make ear pokes seem really really fun again? I did start numbing her ear with the tiniest dab of Emla cream 30 mins before the poke and that seems to be helping a bit. That or it’s placebo effect for me but it’s making me feel better so

I asked her to don the robe for Moonie

 

[Connie & Parker & Moonie]

As a scientist ( biologist), I find so many issues with this “study”. The sample sizes were small, the “controls” were not well defined, feeding was not consistent, some cats were monitored at home and some at the vet, some of the vet-monitored cats did not have their doses reduced after hypoglycemia, there was not a specific protocol followed, there was some selection bias; I could go on and on and the paper is old and I have not seen anything that shows the results were repeatable which is vitally important before drawing conclusions.

I also have firsthand experience with this. I met with a feline only board-certified internal medicine vet not long after Gracie was diagnosed. She saw the bouncing and told me I was “killing” my cat and she was clearly not diabetic. I posted here and members encouraged me to not stop insulin. As a compromise, I dropped her dose back a bit. Her BG shot up as soon as her depot drained. I took her dose back up.

What happens when you reduce the dose is the bouncing can stop but that’s because the BG becomes high and flat.

I’m glad Wendy told you the history of the Relaxed Lantus forum and their rebound checks. They run a FB group and are still doing the same thing. We have had many members come here because their cats were making no progress.

I agree with Wendy, if you all & Moonie need a break, you should take it. But please don’t let her stay long at a dose that isn’t working. And remember it can take up to six cycles for the depot to drain.

We’ve seen cats who bounced for a couple years and then went OTJ in less than a month. I wanted to link their SSs but they have been gone a while and the CGs deleted their SSs.

We are here to support you all.

Thanks, Marje. I don't disagree. So far, we've seen flat yellows and blues, which we were seeing on 3u anyway - it's just now we don't even have the flashes of green nadirs. While we haven't been testing frequently enough to accurately assess the nadir, based on what we're seeing on her +2 drops I would guess that her nadirs have been in the mid to low 100s in the 4 cycles we've had on this reduced dose.

The bright spot is that even two days of light testing seems to have made a difference in Moonie's willingness to be tested again. She came to her testing room on her own and plopped for me this morning for the first time in over a week. It's been a good reminder for me that I need to be more judicious in picking the highest value times to test rather than just doing it for data. I also think my testing technique needs work - I still hit the vein occasionally and I see tiny bumps on Moonie's ears that I think may be hematomas. Elizabeth suggested using the Vetericyn Anti-Microbial Wound Care spray on the ears and I've started doing that, and I always apply pressure after - but maybe I can also start pressing on her ears with a cool compress after. I also bought one of those crazy head lights so that I can hopefully see her veins better.

I didn't know that there were cats who could bounce for a couple years and then go OTJ. I think I anchored so hard to the flat greens at 3.25u that it's felt like a big kick in the gut to see the bounces on 3u. While regulation and remission aren't guaranteed (and are statistically lower likelihood for us), it still gives me hope that it's not impossible.

And thank you for your support as always

Hopefully this period will serve as a good break for Moonie and lesson for us to stay patient.

 

[Connie & Parker & Moonie]

If Moonie loves her Lamb Burgini, let her have the few extra carbs. I've seen a few cats do better with a bit higher carbs. It can allow you to give a little bit more insulin, depending on the carb sensitivity of the cat. A post from the vaults, note conversation uses World numbers:

• Feeding Low Carb vs Lower Carb Foods

Thank you! I didn't know she could eat so much until she started eating the Lamb Burgini . She always looks so happy after too.

She is very carb sensitive, both in the carbs raising her blood glucose and in her sensitivity to sniffing out high carb content for consumption

That's good to know that some cats do better with a bit higher carbs and it's ok to let her have it on a slightly higher dose in the future.

 

[Connie & Parker & Moonie]

I asked her to don the robe for Moonie

View attachment 79627

I think Blair's witchy powers must have worked because Moonie came to her testing room on her own today and plopped! So please say thank you and give extra scritches to Miss Blair Witch for me