7/11 Mami Cat - PMPS 143 +7 51 + 11 169 - No shot - Asking for guidance

Hello everyone. I'm new here, and I was hoping you could give me some guidance if possible.

Mami Cat is still having preshot numbers between 100 and 150. However, whenever I give her just one drop of insulin, her BG drops extremely fast and goes very low. I end up having to steer her with a little glucose and food because, as soon as she reaches 40, I intervene. I no longer wait. Right now, even a single drop makes her drop incredibly fast.

With one drop, she spent almost the entire cycle between 40 (or about 53 after giving glucose) and 100.

According to the preshot number, the dose should still be given, following the Tilly TR protocol. But when I give the smallest possible dose, it seems far too strong. My cat weighs only 2.8 kg (about 6.2 lbs). I tried steering the cycle with food by offering her 10 grams of filet mignon, which she absolutely loves. It helped somewhat, but her BG still drops extremely fast. The only difference was that reaching the 50s took a little longer with the meat. She stayed slightly higher for a while before continuing to drop. I could try giving even more meat along with her low-carb food, but it still feels like I'm forcing the situation because of how quickly the initial drop happens. The BG starts falling almost as soon as the insulin begins to work.

Last week, almost every single day she reached the 40s (and below) on just one drop. Because of that, I stopped giving insulin on Friday night, at least for now. I was exhausted and afraid I might be doing more harm than good.

I truly want to continue. I want to help her. We've come so far, and I don't want to give up. I want to keep moving forward with faith. But one drop has become too much for her.

Given all of this, I decided to stop the insulin temporarily and simply observe what happens. Without using Lantus, her numbers do come down on their own throughout both the day and the night, but they generally stay between 100 and 150. By morning, they're usually around 90 to 100.

However, last night something surprising happened. Her BG dropped to 51 while she was sleeping, and the Libre still showed a downward arrow, so it looked like she was going to keep dropping. Her liver immediately responded by releasing glucose, and her BG quickly went back up to 116. In other words: without any injected insulin at all, her BG spontaneously dropped to 51 overnight.

I'm afraid of ruining everything because you all know how much work and dedication it takes to get to this point. I really don't want to lose all the progress we've made.

My questions are:

• Could my cat simply be atypical and remain stable "forever," or at least for quite some time, with BG mostly between 100 and 160? In other words, could this become her "new normal" for a while without necessarily being a problem?
  
  
• Is there a chance that, if I leave her off the one-drop dose, her pancreas and beta cells will continue healing and finish adjusting on their own? I feel we're very close, but she still isn't spending most of her time between 60 and 100. Without the drop, she spends most of the day between 100 and 150.
  
  
• What would you do in this situation? Should I try feeding her more and attempt the one-drop dose again? One drop has become very strong both during the day and at night. At night, her liver reacts very aggressively to the drops, causing her BG to shoot back up, and then it starts dropping again. It becomes a constant seesaw whenever I give even a single drop. ou can probably imagine how I feel.
  

It feels like she was very close to spending most of her time surfing between 60 and 100 with good stability. I truly believe it's possible. I would really appreciate hearing your thoughts. Do you have any suggestions? Or is there anyone on the forum who has experience with a situation like this and might be willing to offer some guidance?

:: One additional detail: toward the end of the night, she seems to experience something similar to the "dawn phenomenon", and her BG suddenly rises. One of the moderators suggested feeding her at +9, and that advice was great. It has helped tremendously, and now her AMPS numbers are much lower.
This conversation is here: Hello to all! New member - Introducing Mami Cat + I need help

Thank you all so much.

Welcome Clarice and Mami Cat! Wow she is really reactive to that drop! I don't have the answers to your questions, but want to bump this up to the top of the page - hopefully an experienced person can stop by soon and give some feedback.

That 51 could potentially still be depot influenced (Sticky - What is the Insulin Depot?)



But I believe cat's BG do fluctuate up and down even without any insulin.

Keep asking questions! You're doing great. Mami Cat is very pretty

bump.

Seth&Bell said:

Welcome Clarice and Mami Cat! Wow she is really reactive to that drop! I don't have the answers to your questions, but want to bump this up to the top of the page - hopefully an experienced person can stop by soon and give some feedback.

That 51 could potentially still be depot influenced (Sticky - What is the Insulin Depot?)
View attachment 79331


But I believe cat's BG do fluctuate up and down even without any insulin.

Keep asking questions! You're doing great. Mami Cat is very pretty

Click to expand...

Hi Seth!

Thank you so much for your warm message. It really made me happy. I've been a bit of a lone wolf for quite a while, so it was such a relief to find this Forum.

Mami Cat came from the Middle East... it's a beautiful and intense story. Some of her features are different from the other cats around here. I think she's gorgeous, but I might be a little biased

I'm often so amazed by the cats that are still calmly higher at +2 or +3. How come? That hasn't happened with Mami in a very long time...

She feels so close to being stable between 60 and 90. So close. My heart aches because I'm trying so hard to find the missing piece. I was feeling quite sad about it yesterday. That's one more reason why it was so nice to hear from you. I truly hope there's a solution.

She is stable and feels well between 90 and 160, and having two days without dropping into the 40s so often was really good for her. Apparently, she feels much more comfortable now.

About the depot, thank you so much! I was actually thinking about giving the shot in a different area of her body, just to see how it goes. I also think that the 51 was somehow her body still adjusting to everything that's been happening. I know that's not really backed by science, but sometimes I feel like the liver has a sort of memory and keeps repeating certain patterns for a while. The body is so amazing.

I really hope I will find some answers, and I'm also praying for a insight along the way. I have faith...

Thank you too for the bump, Seth.

I'll be definetely rooting for lovely Bell

I agree she seems close to being stable in the normal range. I don’t think her strong reaction to a drop is a bad thing, I’m curious what other folks think. It may just be a matter of smoothing out those big dips with carbs.

Bumping for visibility

Hi Clarice, I hope you are doing well! Sorry your question didn't get answered... How is Mami Cat doing?

My advice would be to make a new thread every day and link the previous one, and keep asking your questions, someone will get to you! Also keep updating your spreadsheet just like you have been doing.

I went digging through some of the archives and found this thread where someone had a similar problem of the drop dose driving numbers under 50:
? - 22/8 Shakti- skipped due to low values in the night -- Urgent dosing question for PM shot in 30 mins

Elise has some good advice in there.

Bumping you up!

I see you are using the Libre for testing. Have you ever tried using a hand held blood glucose meter to test some of those lows? Some people find the Libre tests a lot lower than a BG meter in low numbers and we recommend that people double check. It's possible she's not going that low after all.

Another question, how were you measuring a drop of insulin?

I would try using food that is LC cat food, instead of filet to steer her numbers. You do want to give her some carbs. Some cats do better with carbs that are still in the low carb range but towards the higher end, like 8-9%.

Seth&Bell said:

Hi Clarice, I hope you are doing well! Sorry your question didn't get answered... How is Mami Cat doing?

My advice would be to make a new thread every day and link the previous one, and keep asking your questions, someone will get to you! Also keep updating your spreadsheet just like you have been doing.

I went digging through some of the archives and found this thread where someone had a similar problem of the drop dose driving numbers under 50:
? - 22/8 Shakti- skipped due to low values in the night -- Urgent dosing question for PM shot in 30 mins

Elise has some good advice in there.

Click to expand...

Hi Seth! I really wanted to give you a follow-up earlier, but so many things happen while I'm taking care of Mami Cat that I've been replying a bit late.

I'll try to start a new thread more often and link the previous one to it. Thank you so much for caring and for checking on me! I can see there is a group of people who are always around, supporting each other. It feels great.

I'll carefully read the thread you sent me - thank you so much!

Here is my update...

• I've been observing Mami Cat's BG curve over the last few days. Today it looked better. I see small improvements every day. I think I was a bit "traumatized" by last week. It felt as though I had been constantly pushing her BG down for too many days. So I decided to wait, reflect, and think of a strategy before resuming the one-drop dose. I also did that for the sake of my mental health. I was exhausted and, in the end, a little afraid.
  
  
• I'm seriously wondering about this: is it really better to keep pushing her below 50 every day, or would it be better to let her pancreas recover naturally? (I've been thinking a lot about this lately. She didn't seem to feel that well below 55.)
  
  
• I found two articles suggesting that some cats may continue progressing toward remission if they maintain mostly blue numbers after insulin is discontinued.
  
  
• Mami Cat spends most of the day between 100 and 150. (Whole Morning: from 76 to 96 today! ) She seems to feel good and relaxed. But I will definitely continue aiming for remission. That's still the plan... From the bottom of my heart. I'm praying for it too.
  
  
• I know this isn't part of the protocol, but after observing her curve, I might try giving the one-drop dose only once a day.
  
  
• I did some research and bought a new wet food that's a little higher in carbs. I'm waiting for it to arrive so I can see whether Mami Cat likes it. It seems to be a good option that's available in my country.
  
  
• My idea is to give her the higher-carb food at the beginning of the cycle, followed by some filet. The filet starts affecting her BG about two hours later (through gluconeogenesis). It not only stops the drop but also raises her BG a little. When I give her the right amount, the effect lasts for two hours or even longer.
  
  
• That's why I thought about using the wet food plus the filet. They might help smooth out her curve at two different points in the cycle.
  
  
• The issue is that her BG starts dropping almost immediately after the shot. So I don't even know whether the carbs (new food) will be able to slow the drop at all. I'll have to try and see.

Seth, I do have another question... When you all here on the Forum talk about carbs and their percentage, are you referring to the %ME Carbs value? There are three different carbohydrate values shown below. This one (below) is the wet food Mami Cat eats every day. I consider it low-carb, and it doesn't cause any noticeable food spikes after her insulin shot.

@Connie & Parker & Moonie, thank you so much for sending me the calculator! I should check the % ME CARBS VALUE, right? I'll get back to you soon.

Thank you all for the support and for making me feel included.



Farmina Matisse Mousse - Lamb
Encurtador de Link

Wendy&Neko said:

I see you are using the Libre for testing. Have you ever tried using a hand held blood glucose meter to test some of those lows? Some people find the Libre tests a lot lower than a BG meter in low numbers and we recommend that people double check. It's possible she's not going that low after all.

Another question, how were you measuring a drop of insulin?

I would try using food that is LC cat food, instead of filet to steer her numbers. You do want to give her some carbs. Some cats do better with carbs that are still in the low carb range but towards the higher end, like 8-9%.

Click to expand...

Hi Wendy, thank you for your message!
@Wendy&Neko

• Mami Cat is using the Libre 1. I only compared it with a handheld blood glucose meter once, while we were at the clinic some time ago. At that time, the readings matched very closely. So I don't use a BG meter at home. I'm still not skilled enough to prick her ear. (I feel a little embarrassed to admit this, but it's true.) Even if there is some variation between the Libre and a BG meter, I can usually tell from Mami Cat's body language and behavior when her BG is genuinely very low. The Libre is also very helpful because it clearly shows the sharp swings during the night cycle: her liver suddenly releases glucose, her numbers rise quickly, then they drop again, and it becomes an endless accordion.
  
  
• Regarding the drop dose: I found an old thread here on the forum about using calipers, with videos, and also a ruler from the German Forum. What I do is draw up the insulin into the syringe and then push it all back out. When there is only a tiny droplet left clinging to the tip of the needle, I pull that droplet back into the needle and inject it. That's what I call a "drop." It's such a tiny amount that it doesn't even fall off the needle - it just stays attached to the tip. (I hope this is correct.)
  
  
• Yes, Mami Cat eats LC wet food every day: at +9, as you suggested in another thread, at shot time, and then several more times throughout the morning, afternoon, and evening, including to help slow her drops. While she's on Lantus, she hardly has any food spikes from her wet food. In addition to that, I discovered a few months ago that filet slows and smooths out her curve about two hours after she eats it (gluconeogenesis). It then continues supporting her BG for at least another 1½ to 2 hours, helping prevent her second significant drop - as long as I give the right amount in proportion to the insulin dose and how fast she's dropping. Mami Cat usually has two pronounced drops during each cycle. The filet helps with the second one
  
  
• I also replied to Seth's message above. Would you mind telling me if I'm using the carb calculator correctly? Is the %ME Carbs value the one I should be looking at?
  
  Thanks a lot.

Hi Clarice, sorry I should have pointed out that Elise is tiffmaxee in the thread I linked. She is a very experienced member (as is Wendy who jumped in)

I not very experienced in the carb calculation so I don’t want to steer you wrong, someone else should be able to confirm that for you. See this post from Sienne:
Acana New Wet food

And Jill’s here
Calculating % Calories from Carbohydrates

I think the key is how accurate the data is that you plug into the calculator. People here were working on contacting companies to update the food charts:
https://felinediabetes.com/FDMB/thr...g-as-fed-cat-food-values-in-one-place.301957/

Also, the advice here for Lantus is to always maintain the 2 shots a day, 12 hours apart, since the insulin works on a 12-hour cycle. Hopefully folks here can work with you to use carbs to keep Mami Cat in a more comfortable zone with the drop dose.

Clarice & Mami Cat said:

I only compared it with a handheld blood glucose meter once, while we were at the clinic some time ago. At that time, the readings matched very closely.

Click to expand...

Can you tell me what day you did that comparison and what the two numbers were? It's in the lower ranges that the Libre tends to read lower than a human hand held meter.

For drop dosing here, we suggest people push the plunger hard on the syringe, then insert the syringe into the vial/cartridge/pen, then release the pressure on the plunger. That vacuums up a drop. Might want to see what happens when you do that. She needs to be seeing more numbers under 100 to be considered ready to go without insulin. More details in this post Reminder: *earning* reductions and starting OTJ trials

I am glad Wendy answered. Right before I read your thread I saw your pm. Would it be possible to have your vet or a tech show you how to do an ear prick? I was afraid to do it at first but learned how. It does not hurt them. Staci can confirm that lows are often not that low on the libre when compared to an ear prick.

Seth&Bell said:

Hi Clarice, sorry I should have pointed out that Elise is tiffmaxee in the thread I linked. She is a very experienced member (as is Wendy who jumped in)

I not very experienced in the carb calculation so I don’t want to steer you wrong, someone else should be able to confirm that for you. See this post from Sienne:
Acana New Wet food

And Jill’s here
Calculating % Calories from Carbohydrates

I think the key is how accurate the data is that you plug into the calculator. People here were working on contacting companies to update the food charts:
https://felinediabetes.com/FDMB/thr...g-as-fed-cat-food-values-in-one-place.301957/

Click to expand...

Seth&Bell said:

Also, the advice here for Lantus is to always maintain the 2 shots a day, 12 hours apart, since the insulin works on a 12-hour cycle. Hopefully folks here can work with you to use carbs to keep Mami Cat in a more comfortable zone with the drop dose.

Click to expand...

Hi Seth,

Thanks a lot, once again, for all the useful information. I used the FDMB calculator, but I'll double-check it all.

Indeed... I should keep giving two shots a day - or at least do so as consistently as possible at this stage.

I'm doing my best to figure this out so I can move forward with a plan and feel confident about it.

Thank you so much for all your support since I joined the forum

Wendy&Neko said:

Can you tell me what day you did that comparison and what the two numbers were? It's in the lower ranges that the Libre tends to read lower than a human hand held meter.

For drop dosing here, we suggest people push the plunger hard on the syringe, then insert the syringe into the vial/cartridge/pen, then release the pressure on the plunger. That vacuums up a drop. Might want to see what happens when you do that. She needs to be seeing more numbers under 100 to be considered ready to go without insulin. More details in this post Reminder: *earning* reductions and starting OTJ trials

Click to expand...

@Wendy&Neko

Hi Wendy,

It's really great to hear about the drop dosing technique. I'll practice it and test it. Many thanks! This is so helpful.

Got it... Thank you. The comparison between the two meters was done at the vet clinic months ago, and they matched. She was on 67, if I remember correctly. I'll see if I can find a way to double-check it the next time it happens.

In any case, she drops fast and she goes quite low. This is the main point... Even without Lantus, she displays the same pattern in the morning. She drops quite a lot on her own. Maybe it's her circadian rhythm (?).

To be able to move forward, I need to learn how to steer her curve with the right amount and type of food, then. I bought a new wet food with a higher carb content, and I'm hoping it will help. It should arrive soon.

One final question for now: here on the FDMB, when people refer to LC, are they using %ME carbs (estimated) as the reference? Or the carbs dry matter? (see below)

Thank you!!

tiffmaxee said:

I am glad Wendy answered. Right before I read your thread I saw your pm. Would it be possible to have your vet or a tech show you how to do an ear prick? I was afraid to do it at first but learned how. It does not hurt them. Staci can confirm that lows are often not that low on the libre when compared to an ear prick.

Click to expand...

@tiffmaxee

Hi Elise! I will find a way to ask a vet to support me, or to teach me how to, properly. It will be useful... for sure.
In any case, the main point is about feeding her strategically. She drops super fast and goes really low. It got too intense last week.

Thanks a lot!

Hi Clarice! I am in no way experienced enough to offer any dosing advice, but the experienced people here have only guided me in the right direction.

But as for feeding the curve, I do think I have a few pointers for you! So the best way for me to decide when I should feed the curve with Khloe is based on the variance %, I find the actual number difference to not be very helpful.

I have a hard time doing the math in my head and I get frustrated doing the math on a calculator all the time. So here’s a simple calculator I made that will do the math for you if you’d like to use it. Just “make a copy” like you did when making a SS and you can manually type in your BG numbers. Or you can always do the math yourself if you would prefer!
Variance Calculator

Anything within 20% and -20% is within the allowed range of error for meters (this may be different outside the US). So if she’s within the range, I do not feed as she’s staying “flat”.

Anything above 20% is considered rising.
And anything below -20% is considered dropping.
So let’s say Khloe had a variance of -50% from AMPS and +2, that tells me that she is dropping really fast so I need to feed the curve (even if the number isn’t green). I always try to start with LC first, test 30 mins to a hour later (depending on how low the number is) to see if she’s continuing to drop or if she’s going flat. If she is continuing to drop fast, I personally like to mix alittle honey (2/3 drops is what I do) or MC food with the LC to create a “higher LC”, and I’ll move to either MC or HC if she’s still dropping fast early in the cycle. But I rarely ever use MC, and only used HC maybe once. I usually will never feed after the nadir (which for Khloe is usually +6 the latest, ECID tho!!) but there’s obviously exceptions to this rule if she’s too low or still dropping.

As for the Libre readings, I have heard that lows tend to read lower on the Libre vs a handheld meter so Mami may not actually be going as low as you think. Maybe @Staci & Ivy can give you some tips and tricks for it as her Ivy uses a Libre

And the last thing to my extremely long winded message lol, I don’t use the online calculators for carb %. So I don’t have an answer for if it’s ME or Dry matter. I strictly use the food charts found here in the forum. I also stick strictly to cat food only and do not feed human food so I can know exactly how many carbs I’m giving her.

I don’t always explain things the best, so please let me know if that is confusing. And I hope it answers your question!

Sara & Khloe said:

Hi Clarice! I am in no way experienced enough to offer any dosing advice, but the experienced people here have only guided me in the right direction.

But as for feeding the curve, I do think I have a few pointers for you! So the best way for me to decide when I should feed the curve with Khloe is based on the variance %, I find the actual number difference to not be very helpful.

I have a hard time doing the math in my head and I get frustrated doing the math on a calculator all the time. So here’s a simple calculator I made that will do the math for you if you’d like to use it. Just “make a copy” like you did when making a SS and you can manually type in your BG numbers. Or you can always do the math yourself if you would prefer!
Variance Calculator

Anything within 20% and -20% is within the allowed range of error for meters (this may be different outside the US). So if she’s within the range, I do not feed as she’s staying “flat”.

Anything above 20% is considered rising.
And anything below -20% is considered dropping.
So let’s say Khloe had a variance of 50% from AMPS and +2, that tells me that she is dropping really fast so I need to feed the curve (even if the number isn’t green). I always try to start with LC first, test 30 mins to a hour later (depending on how low the number is) to see if she’s continuing to drop or if she’s going flat. If she is continuing to drop fast, I personally like to mix alittle honey (2/3 drops is what I do) or MC food with the LC to create a “higher LC”, and I’ll move to either MC or HC if she’s still dropping fast early in the cycle. But I rarely ever use MC, and only used HC maybe once. I usually will never feed after the nadir (which for Khloe is usually +6 the latest, ECID tho!!) but there’s obviously exceptions to this rule if she’s too low or still dropping.

As for the Libre readings, I have heard that lows tend to read lower on the Libre vs a handheld meter so Mami may not actually be going as low as you think. Maybe @Staci & Ivy can give you some tips and tricks for it as her Ivy uses a Libre

And the last thing to my extremely long winded message lol, I don’t use the online calculators for carb %. So I don’t have an answer for if it’s ME or Dry matter. I strictly use the food charts found here in the forum. I also stick strictly to cat food only and do not feed human food so I can know exactly how many carbs I’m giving her.

I don’t always explain things the best, so please let me know if that is confusing. And I hope it answers your question!

Click to expand...

As I noted above the Libre “can” show values that look lower than they actually are on a handheld meter with an ear prick.

I think it’s very important to be able to test low Libre numbers (especially under 50).
With Ivy a “Lo” Libre reading can be 60-100 on a handheld meter.
Or, a 55 on her Libre can be 100-130 or so on a handheld meter.
However, I have seen other cats here where their Libre and their handheld meters in those ranges were only 10-20 points apart, so it’s very important to know how Mami is truly reading when in lower BG ranges.

I hope this helps!

Sara & Khloe said:

Hi Clarice! I am in no way experienced enough to offer any dosing advice, but the experienced people here have only guided me in the right direction.

But as for feeding the curve, I do think I have a few pointers for you! So the best way for me to decide when I should feed the curve with Khloe is based on the variance %, I find the actual number difference to not be very helpful.

I have a hard time doing the math in my head and I get frustrated doing the math on a calculator all the time. So here’s a simple calculator I made that will do the math for you if you’d like to use it. Just “make a copy” like you did when making a SS and you can manually type in your BG numbers. Or you can always do the math yourself if you would prefer!
Variance Calculator

Anything within 20% and -20% is within the allowed range of error for meters (this may be different outside the US). So if she’s within the range, I do not feed as she’s staying “flat”.

Anything above 20% is considered rising.
And anything below -20% is considered dropping.
So let’s say Khloe had a variance of -50% from AMPS and +2, that tells me that she is dropping really fast so I need to feed the curve (even if the number isn’t green). I always try to start with LC first, test 30 mins to a hour later (depending on how low the number is) to see if she’s continuing to drop or if she’s going flat. If she is continuing to drop fast, I personally like to mix alittle honey (2/3 drops is what I do) or MC food with the LC to create a “higher LC”, and I’ll move to either MC or HC if she’s still dropping fast early in the cycle. But I rarely ever use MC, and only used HC maybe once. I usually will never feed after the nadir (which for Khloe is usually +6 the latest, ECID tho!!) but there’s obviously exceptions to this rule if she’s too low or still dropping.

As for the Libre readings, I have heard that lows tend to read lower on the Libre vs a handheld meter so Mami may not actually be going as low as you think. Maybe @Staci & Ivy can give you some tips and tricks for it as her Ivy uses a Libre

And the last thing to my extremely long winded message lol, I don’t use the online calculators for carb %. So I don’t have an answer for if it’s ME or Dry matter. I strictly use the food charts found here in the forum. I also stick strictly to cat food only and do not feed human food so I can know exactly how many carbs I’m giving her.

I don’t always explain things the best, so please let me know if that is confusing. And I hope it answers your question!

Click to expand...

@Sara & Khloe

Hi Sara,
First of all, thank you so much for taking the time to reply and for helping me with so many details
Mine will be a bit longer... Here we go...

I had never used the variance percentage before. I usually look at the numbers themselves, and I'll explain why in a minute. But I really liked your approach. If I may ask, did you learn about the variance (%) idea from an article or here on the Forum, or is it something you came up with yourself? If it's your own idea, I think that's really clever.

Thank you so much for sharing your calculator with me. I'll definitely use it and play around with it. I understood what you explained about values below and above 20%, and I'm going to write it down so I don't forget.

I actually do exactly what you described and only feed LC food. I also liked your idea of mixing MC with LC. I usually feed Mami Cat after nadir whenever she's hungry or asks for food. Otherwise, I wait.

About the Libre, I use the Libre 1 and make sure it's attached really well. If it starts coming loose, the readings definitely become less reliable. When I compared it with a handheld meter at the vet, though, the Libre 1 (unlike the newer Bluetooth versions) matched the handheld meter very closely. I'll check that again next time just to be sure. (I will try my best to do it.) For me, the biggest issue isn't whether the Libre is off by 10 or 20 points. It's how fast and how deeply Mami Cat drops. Even if the reading is a little off, the speed of her drops still means I have to feed the curve.

Regarding carb calculations, I only wanted to know which carbohydrate percentage people here use as the standard reference so I could make sure I'm buying the right LC food. I also don't use it daily. Since I live in another country, that's important for me. Thanks to the link Seth sent me, I found that the value I should probably be looking at is %ME (percentage of calories from carbohydrates), but I'll confirm that with @Marje and Gracie.

Marje, is % ME the right value to use to determine whether the LC food I use is actually low carb? Many thanks!

Now let me tell you a little about Mami Cat... I don't think she follows the usual Lantus pattern. Currently, if her AMPS is around 180 or higher, she'll often be around 53 by +2.20. Then she'll usually have another smaller drop around +3.20, followed by another one around +5, which I currently consider her nadir. For her, the onset is basically immediate. I give the insulin, and she starts dropping right away. That's why I don't think she responds to Lantus in the typical way.

Because of that, I had never thought about using the variance percentage you mentioned. Her drops are so fast that it's become obvious I'll probably need to give her something with more carbs right from the beginning. When she drops too much, I usually give LC food, Hill's a/d, and 1 mL of glucose. Sometimes I also use Malte Paste. I don't know what it's called in the US, but the effect is immediate.

I actually stopped the insulin for a few days while I waited for the MC food I ordered. Even without Lantus, she dropped from over 200 to around 60 early this morning. I've attached the graph below. There seems to be something about her own body in the morning that makes her BG fall naturally. Between about 6:30 and 8:00 a.m., she almost always drops by at least 100 points, even without insulin.

That made me wonder whether, if I wanted to work with what her body naturally does, giving insulin around 2:00 p.m. would actually make more sense. Of course, that would mean the evening shot would have to be around 2:00 a.m., which isn't practical, so I don't do it. But giving Lantus right when her body is already making her BG fall seems to make everything happen even faster.

I've read the TR protocol many times, and I really do want to follow it as closely as possible. But I also feel there's something different about Mami Cat that I need to pay attention to. I know this isn't part of the protocol, but right now I'm wondering whether a one-drop dose once a day, only at night, might suit her better by creating a smaller depot. I honestly don't know yet. I'll just have to observe and see what she tells me. I think Lantus lasts longer than 12 hours for her.

As for feeding, my plan is to use a higher-carb food during that first part of the drop. After that, I switch to filet mignon. The reason is interesting. With Mami Cat, filet seems to flatten her curve. About two hours after she eats it, the amino acids start contributing to new glucose production, and her numbers become amazingly stable. They don't drop much, and they don't rise much either, for quite a while, depending on how much she eats. Finding that out was a huge breakthrough for us. She absolutely loves it, it's an excellent source of high-quality protein, it also helps with anemia, and it gives the insulin something to work with instead of letting the curve keep falling. So my plan is carbs first, then the meat kicks in about two hours later.

At night, it's completely different. If her PMPS is around 115, she can drop dramatically within just 30 minutes and then spend the rest of the night bouncing every few minutes: 53 → 116 → 60 → 120 → 59 → 124... something like that. I don't think that's good for her. It's just too much up and down. Her liver seems to get scared and tries to protect her from hypo, but I don't think that constant bouncing is healthy for her little body. I feel like she's trying to tell me something, and I need to listen.

I also don't know what it's like to have a flat curve. The only time Mami Cat sometimes stays flat is after dropping into the low 50s, when she'll sit around 53 for a couple of hours before starting to rise again. I'm always amazed when I see the beautiful flat curves so many cats have here. They start at 90, get a drop dose, and stay almost at the same number the whole cycle. I honestly don't know what that's like. Ever since Mami Cat's numbers started improving, she's always had big drops long before nadir.

If I continue using Lantus at this drop-dose stage, learning how to feed the curve properly is going to be essential. I'm praying that I'll find the right solution for her.

Thank you so much for everything you shared here.

May Khloe continue making wonderful progress

Staci & Ivy said:

As I noted above the Libre “can” show values that look lower than they actually are on a handheld meter with an ear prick.

I think it’s very important to be able to test low Libre numbers (especially under 50).
With Ivy a “Lo” Libre reading can be 60-100 on a handheld meter.
Or, a 55 on her Libre can be 100-130 or so on a handheld meter.
However, I have seen other cats here where their Libre and their handheld meters in those ranges were only 10-20 points apart, so it’s very important to know how Mami is truly reading when in lower BG ranges.

I hope this helps!

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@Staci & Ivy

Hi Stacy - thanks a lot!

The one I use is the Libre 1, which is actually a little different from the newer version, right?
It really does need to be very well attached to Mami Cat's body. Otherwise, the readings can indeed become unreliable.

I've heard people here in my country (at the vet clinic) say that it can be off by about 10 points, sometimes even 20. But when I checked it at the vet clinic, Mami Cat's was right on target, very accurate, at around 63.

Anyway, thank you so much for letting me know. I'll find a way to double-check those readings below 50... I will have to find a way.

In any case, her situation requires attention. I need to learn how to manage her curve with food. Her drops are incredibly fast and very deep.

Thank you and send my love to Ivy

Clarice & Mami Cat said:

@tiffmaxee

Hi Elise! I will find a way to ask a vet to support me, or to teach me how to, properly. It will be useful... for sure.
In any case, the main point is about feeding her strategically. She drops super fast and goes really low. It got too intense

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I would try feeding a little slightly higher carbs at +1 and +2 to slow down the drop. It looks like she onsets at +2.

Clarice & Mami Cat said:

Regarding carb calculations, I only wanted to know which carbohydrate percentage people here use as the standard reference so I could make sure I'm buying the right LC food. I also don't use it daily. Since I live in another country, that's important for me. Thanks to the link Seth sent me, I found that the value I should probably be looking at is %ME (percentage of calories from carbohydrates), but I'll confirm that with @Marje and Gracie.

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Hi Clarice

Please be sure and start a new condo tomorrow. Here are our posting guidelines and we ask members to post accordingly.

You want to use the as-feds or DMB carbs, not the %ME.

I know you said you compared the Libre1 to the vet’s meter but how many times? A few tests are insignificant to make a correlation. On the PM cycle of 7/11, it’s possible she dropped to 51 but if you didn’t feed that number, rising to 116 that fast is very unusual. I would question the validity of that 51. That’s why learning to test her with a handheld would be very beneficial.

The +9 feedings aren’t really helping her and I wouldn’t feed her anything after nadir unless she is below 50 and then I would try LC. If she’s really hungry, a LC snack like boiled chicken breast or freeze dried chicken would work.

I’m also not so convinced she has dawn phenomenon. We’ve had members using Libres for a long time and they have consistently run lower than a handheld meter. Here are testing and shooting tips with videos.

She looks to me like she could use the drop of insulin twice a day. But I would also try to learn how to poke her so you can get some comparisons at home.