03/31/12 Ella PMPS 412

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tpr

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It's sunny over here in Toronto this AM at 221. I'm a little bitter that my kitties didn't let me sleep in but they're making it up to me with cuddles.
 
Re: 03/31/12 Ella AMPS 221

191 +1. Ella is hungry despite the fact that she ate her 1/4 cup an hour ago. Whenever her bg drops she goes into survival mode. Is it better to spread her food out between PS and +1,+2? I guess that would require an auto feeder in my case as I can't be around to accomodate her.
 
Re: 03/31/12 Ella AMPS 221

Hi Ella and TPR,
I just got caught up on your yesterday and hope that you will have time this weekend to read Dr. Pierson's articles on nutrition and diabetes that Sienne recommended yesterday. Here's the link to her website again: http://www.catinfo.org/
Ella will really benefit from eating low carb, wet food. Switching from dry (especially the prescription dry) to low-carb, commercial wet food has had terrific results for so many kitties here. Wellness Turkey is Rusty's primary food and he is doing very well. It is higher in calories than some of the other low-carb foods, however. If you are worried about weight gain, I would echo what the others said yesterday: it is the calories that must be watched, not the fat content.
Most vets are not "up" on the modern approach to Feline Diabetes. They still stick to what they learned in vet school (and you can well imagine that FD was just one of so many things they had to learn about). So be prepared to do what so many of the rest of us do: nod when your vet tells you what to do about Ella's numbers, and then do your reading (that includes reading other kitties' spreadsheets and other condos) and decide for yourself--with the help of the board--what course to take. I don't discuss Rusty's diabetes at all with his vet except to tell her that he is doing well. She's a good vet in so many other respects.

Enjoy your weekend and I hope you can get started soon on the transition to lo-carb wet food.

Ella & Rusty
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Thanks Ella! I think Julie passed on this article to me a while back but I need to re-read it.
I have a question about the bouncing. If she is bouncing because her body is not used to the low numbers but she is still getting very high numbers, would that be reason to increase her dose so that she can get used to lower numbers througout her cycle?
She's been on 3u's for a long time and it doesn't seem to be helpign her regulate even numbers. Right now her bg is dropping and she is nervous. I know her dry will kick in soon but if her liver send out counter regualltory horomones before her dry kicks in then she will sky rocket. I can't seem to get her out of this cycle on the units she is on. If this keeps happening, doesn't it sound like an increase is in order?
 
Re: 03/31/12 Ella AMPS 221 feeding question

Hi again,
As others have said, it is much easier to regulate a cat when feeding wet food because dry takes too long to kick in and too long to leave the system. I really don't have an answer to your "bouncing" question, but I would suggest that you re-read Marjorie's and Gayle's posts in your yesterday's condo. One of the problems of raising the dose when a kitty is bouncing is that she will respond to the new dose and dive into much lower numbers. Then her body will react and she will bounce again, maybe even higher. This all contributes to a roller-coaster effect and is to be avoided. It is not clear to me that you will be able to stop this bounce-dive cycle until you switch to wet food. Perhaps you should stock up on some of the Fancy Feast "classic" (paté) flavors this weekend and see if Ella likes them.

I agree with Marjorie that you should not increase Ella's dose at this time, but try to get some more mid-cycle tests this weekend. Here is the link to your condo yesterday: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=67554
I hope one of the very experienced dosing people will be along to guide you.

Ella & Rusty
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Ok I re-read the article regarding nutrition. It was very informative and convincing. I also read the feline diabetes article and paid particular attention to the "Switching the Diabetic Cat to a Low Carbohydrate Diet" section. I know that switching to wet food means I need to monitor very closely so that she doesn't go hypo but I haven't read an article that tell me how to do it. Is there some kind of recipe that I should aqaint myself with or is it trial and hopefully not error?
I know I've said this like 100 times but my main fear with this transition is not being home if she goes really low or vomits from the wet and needs more food to compensate for the insulin. Is it possible to do this TR successfully with my schedule and lack of flexibility to stay home?
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

I've perused quie a few spread sheets over the last liitle while and can see that many lucky cats have their owners home to test during the day. I wish that was me:)

Just took Ella's bg at +2.5 and she is 266 so she's on the rise already.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

For switching food and adjusting dose, it all depends on your plan and how Ella reacts.

Let's say that Ella likes her wet food, so there would be no problem in dropping her dose back to 1u or some lower dose than her 3u, and removing all the dry food. Many people give wet food as a 'treat' when it should really be the entire diet, and the cats are likely just loving the switch to the wet.

With dry food in the cat's system, it's not going to disappear and result in a huge sudden drop in BG.
I would think to cut Ella's dose in half, and then leave more wet food out for her to eat when you are away would work just fine.

When working, I was often away from amps to pmps, so no testing at all during the week days until I got home for the pm shot. By setting up an auto feeder, you can section out the day's food into portions and Ella can have food available all the time, so you needn't worry about her dropping while you are away.... most cats will seek out food when they go lower; they self regulate their numbers.
Just like when you are thirsty, you get something to drink, so do the cats, with water when thirsty, and with food when hungry or feel their numbers low.

You can plan the food switch trial for a day or two that you will be around so you can watch.
There's no recipe for the change because every cat is different. I would say dropping the dose and switching all at once would be my first attempt, and then if that did not work, try some of the compromises. Just like with that bandaid, ripping it off quickly is sometimes a pretty good way.
You will watch for changes in the litter box, and you will definitely see less water drinking; others who have made the switch can give you other signs you may see.

For your own fears, make a plan to prepare for the switch. There is no point in upping her dose because it will just be more dangerous when you switch foods.
You said it yourself, the dry food is causing her lousy numbers.
I know her dry will kick in soon but if her liver send out counter regualltory horomones before her dry kicks in then she will sky rocket.
Once you are feeding food that is not sending her numbers to soar, you will then see how much insulin, or how little insulin she really needs.

Get the auto feeder, divide up her day's worth of food in the compartments, then start the change on a day you are home.

Lots of people here to help you too.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Many of us are not home during the day. I work full time but have arranged my shot schedule around my work schedule.

There really isn't a one size fits all recommendation on how to transition. The reason is that there's no way to accurately predict what will happen since some cats are more carb sensitive than others. If you are worried about the potential for hypoglycemia, transition all at once on a weekend when you can be there to monitor. You can also drop the dose to offset the change in carbs.

What I would point out is that Ella started this cycle at 221. She dropped a little to 191 at +1. While the drop is within the range of meter variance, the spike to 266 is probably not meter variance and, in all likelihood, is the influence of the dry food.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Gayle,

Ok so this might be a silly question but does an auto feeder do wet food? Is there some sort of feeder that keeps food chilled?

Sienne, if the numbers are affected by the food, is it still considered a bounce if she sky rockets into the 400's later on or are bounces only affected by insulin?

Gah, forgive me...still learning:)
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

everybody farther along in this process uses only canned food - and yes, we use autofeeders. ella has one that allows a blue ice - i just put the canned food in the feeder and if it's more than a couple of hours til he'll be eating it, i set one ice cube on top of the food in each compartment. i use the Petsafe 5 Compartment Feeder and really like it. there are a few complaints on the amazon site about it not opening all the way - that's from a person not getting it seated back correctly. the cure for that is to make sure you have it seated by pressing the button to move it one compartment ahead and seeing that it's correct.

i believe several people have said in the past that they are comfortable leaving the canned food out for 12 hrs at a time.

some people make "pucks" where you mix the low carb canned food with water, freeze it (i've heard ice cube trays and i've heard ziplock bags) then leave the frozen food out to thaw over the course of the day.

it's easy. i sub in schools so my schedule is erratic - when i have to be gone i leave food for punkin in the feeder and i trust that he will be ok. after a while, you get a sense of the patterns for your own cat. you can't see them yet because dry food really mixes the whole thing up.

i think laurie and i were talking with you a few days ago about trying the transition this weekend, but you were thinking you wanted to wait til easter weekend. when we talked then, i think our thoughts were to make the change all at once because ella seems pretty carb sensitive when you were just changing her +9 snack.

bounces occur from one of two things - either the cat's BG dropped very quickly, say more than 50 points in an hour or the cat hit a range of numbers lower than its body is used to. we don't change the insulin based upon a bounce. i'm not sure that i'm answering your question - i don't really understand it.

if you give more volume of food, or a higher carb food than usual, you will need more insulin to compensate for the additional carbs. that's why we like to get the food question settled - serve basically the same carbs, same volume, same times of day - and then we tweak the dose of the insulin to accommodate the food that is needed.

if the food/insulin is in a pretty good relationship and i decide to give punkin extra food today, i wouldn't change his insulin dose. i would just know that i've changed the plan and will have to wait til the extra carbs clear his system and then i will see normal for him again. lantus isn't a fast-acting insulin, so we take a "bigger" perspective, if that makes sense.

when you want to make the change, please tell us so we can have a plan & watch for you if you have questions or need help.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

i just reread your post from yesterday - somehow i'd missed it. i just wanted to comment that it's really common for people to report that their cat seems to get used to high numbers and then seem to feel lethargic when they get to lower ranges. it's not bad for them - you WANT her to get used to being under 100. it's that she's gotten used to being high.

i've wondered if it's just like caffeine in people. our natural state is uncaffeinated, but when people are used to having caffeine, going without sucks and people get headaches and feel crappy. but after a few days of going without, they get used to it and the side effects go away.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

tpr said:
Gayle,

Ok so this might be a silly question but does an auto feeder do wet food? Is there some sort of feeder that keeps food chilled?

Sienne, if the numbers are affected by the food, is it still considered a bounce if she sky rockets into the 400's later on or are bounces only affected by insulin?

Gah, forgive me...still learning:)

There are NO silly questions; every one is good and valid. If you need an answer to something, ask.
Your question is not silly at all; it's very important.

Many people worry about food going bad if left out for hours, so there is no reason you can't prepare ahead by making feeding sized portions and freezing them. You can put 1TBSP scoops on a plate and freeze them. Toss the frozen scoops in a freezer container and then they are all ready to drop into the feeder sections. I never bothered with the freezer thing because if you leave for work, you put down a bowl of wet food and hope it will last the 8 or 10 hrs, right? If you are feeding prepared frozen raw food patties, then the food's already in a state to drop into the feeder.

Now, many animals have issues with plastic containers, and I don't much like feeding in plastic either so I had picked up 5 small glass bowls that fit into the feeder sections. I made for less chin acne, and easier cleaning of the feeder and easier loading of foods into the feeder. There was also less waste as there would not be food spread all out into the corners of each section.

Another thing about the feeder was that I could tell when the food was most being eaten, and when Shadoe was sleeping and could not be bothered with food. I did supplement the 5 portions outside of the feeder. She got her breakfast in a separate dish, as well as her dinner and evening snacks. I used the 5 sections for small meals and snacks for my being away during the day.

I cannot say that high numbers are a bounce if they are from food. I know for a fact that if Shadoe got a small mouthful of dry food, she would be hitting the 400s later that day. No bounce; all nasty dry food carbs.

If you see Ella dropped very low, then is high later, you are not going to need to give her more insulin because her current dose is able to drop her low just fine..... it's just her body that has to adjust to how those lower numbers feel.

Numbers could spike for many reasons, so you just need to determine the cause and it will help you decide what needs to be done. Even meds from the vet can cause a spike; I once got some from the vet in a suspension and it was found to have a sweetener in it, which was not very good for my diabetic cats!
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Hi Julie,

Thanks for your post:) In regards the bouncing you said:
bounces occur from one of two things - either the cat's BG dropped very quickly, say more than 50 points in an hour or the cat hit a range of numbers lower than its body is used to. we don't change the insulin based upon a bounce

Looking at Ella's ss from today does it seem like she might be bouncing? Sienne mentioned that the rise might be due to the influence of the dry food so if that's the case wouldn't that warrant a higher dose?

What other tests would be helpful for everyone to see today?
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Thanks for the adive regarding the feeder Gayle! Sounds like the ice cubes might do the trick. I'm going to go out later and see if my neighbourhood pet supply store carries them. Will post another bg soon.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

326 at +7. We'll see what happens in a while.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

If the higher numbers are due to the food, and you are planning to stay with the dry food, then yes, you may well be stuck with needing a higher dose.

If you are planning to move off the dry food, then it's going to be more dangerous to transition from a higher dose, so best to try the change when at a lower dose.... why wait till you are needing to give 10u shots twice a day, all because of dry food?

It seems more cost effective to change to wet food sooner, and then need to give Ella less insulin, not more insulin.

There have been some cats who refuse, absolutely refuse, to eat wet food. I know. I have one, but she is not diabetic. In those cases, the owners is stuck with giving more insulin to balance off the dry food.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

[
If you see Ella dropped very low, then is high later, you are not going to need to give her more insulin because her current dose is able to drop her low just fine..... it's just her body that has to adjust to how those lower numbers feel]

But even if her current dose might drop her to a low level, over all she still is having big swings. I was under the impression that we wanted her to surf...
I guess my question is, how will her body adjust?
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Hi Ella and tpr,

I understand your concerns about switching from dry food to wet food. We did the change early March and it made a huge difference, so let me share our story. This may not the best or right way to do it and it may not work for Ella (and others), but it has worked for Kitty.... :mrgreen:

In February Kitty was still fully eating dry food. His insulin dose was 2-2.5u BID and usual pre-shot numbers were in mid to high 300s. I travelled for a week from Feb 25 to March 4, and lowered the dose to a safe 1.5u (pet sitter does not test). After I came back, I decided it was time to make the change in diet. Besides dry food, Kitty had had wet food available for abut 1-2 weeks so I think he had gotten used to the smell etc. Litter mate Joey had already started to like wet food ...
During the final 4 day transition period, I gave only wet food at the meal times, but then left some dry food for the day just before I headed to the office. At night he had only wet food. Pls note! my kitties have been free fed all the time (1 FF can / cat both in the morning and evening, thus normally 4 cans of FF during 24 hour period). When transitioning the diet, the insulin dose was lowered from 2u to 1.5u. Thursday March 8th was Kitty's first wet food only day.

Day 1+2 on wet food only diet: As I was working on Thursday and Friday, I did not do any mid cycle testing, though then on Friday night (i.e. 2 days on wet food diet only), his PS BG was 92 and I decided to skip the shot as I was not comfortable to shoot to a low number.
Day 3 on wet food only: On Saturday morning I overslept the normal testing and shooting time, and when I tested at +2 from the normal morning testing, BG was still low at 97 ! Thus, I think it was (semi)ok in Kitty's case to miss both Friday PM and Saturday AM shots. On Saturday evening his PS was 202, and then I gave 1u dose (his previous dose was 1.5u on Friday morning). Kitty reached his nadir at his usual early time at +3 and it was 56.
Day 4 on wet food:On Sunday morning (i.e day 4 wet food only day) after AMPS of 130, I gave again 1u, and Kitty was surfing green most of the day. On Sunday evening the dose was lowered to 0.5u even though he did not deserve the decreased dose yet, however I was going to travel again from Monday evening, so I wanted to start lowering the dose already. Then his BG dropped to 50 at +3
Day 5 on wet food: I skipped the morning shot as his AMPS was lowest ever (121) and I was not a home to monitor. In the evening I went on a business trip, so you can imagine that I was asking the whole FDMB for advise what dose to give. And of course (!) I got the best support and advise :-D and dose was lowered to 0.25u for the time when I was travelling. Pet sitter does not test but even without testing, I did not want to leave any dry food out, but Kitty was on his new wet only diet.

During my 4 days of travelling, Kitty had 0.25u twice a day. When I came back he was in low 200's.
Day 10 (Saturday) on wet food: the dose was increased to 0.5u in the morning and he did a fairly good green surf for most of the day. Evening PMPS was first time green: 86 and I gave again 0.5u. He dropped to 47 at +2.5 testing, and I must say I was not so worried about the low number (probably should have been :oops: ). He was acting normal and I did not even give him any HC food... (= hindsight: SHOULD have probably given the HC food at this stage)
Day 11 on wet food: AMPS was another green: 94. WITHOUT thinking I gave him again 0.5u. He would have earned the reduction to 0.25u the night before, but I DID NOT THINK :oops: . During the first hour he dropped to 32 at +1.5. This was the lowest ever reading, and with Serryn's wonderful help we went through the tight monitoring time. What happened with Kitty was that he started to eat frantically at +1.5 when his BG dropped very low. I gave him HC food a couple of times and at +2.3 he was up to 56. Other than eating frantically, he was acting normal, and I must admit that I was not really worried at any time. I had honey ready in case readings would not have risen or if Kitty had started to have hypo signs, but other than that, everything was quite "normal". Of course I was intensively testing BG. In the evening I gave 0.25u
Day 12 on wet food: Kitty had another low AMPS reading (90) and I skipped the dose. I was again going on a business trip the following day, and I think all the best brains here at LL were thinking what dose do we give to Kitty when I was gone. On Monday evening I gave him tiny shot of 0.1u to which he reacted by going down to 59 at +3 testing
Day 13 on wet food: AMPS was as low as 77! Since this day he has not had any insulin, however this was a bit early and forced start for the OTJ trial... I was going away for 5 days, so it was the safest to choose that he would not have any insulin.

Ever since then Kitty has not gotten any insulin :-D The change in 2 weeks has been just amazing (going from 2u to zero). Besides not needing insulin any more, Kitty has now wonderful shiny coat, he looks 5 years younger and is much more playful than before.

THUS - my recommendation: go for the wet food as soon as you can!

NOTE: Above dose increases/decreases may not be normal and recommended way, but we had to adjust the dosing scheme because of my busy travel season. I have received wonderful support and advise from so many people here in LL, and I would trust their opinions on the dosing. There will be times when you will have to choose if you feel comfortable to shoot to a low number. As you can read from above, I did skip a few times when i was not comfortable, but after a few rounds of low numbers, it was ok. If in doubt, my advise would be to choose the safe way and to skip, but with the right tools (HC food and Karo/syrup/honey and testing) you can manage it just fine! GOOD LUCK!

- Mia & Kitty
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Wow Mia!!! You and kitty are very lucky that she is OTJ so quickly! That is truly amazing!

Thanks so much for sharing your story and there is no doubt in my mind that you received incredible support from the people on this board. Your story gives hope to me and I'm sure many others:)
It also makes me feel a bit better about not being home to monitor as much as I'd like too:)

Do you know what caused Mia's diabetes?
Ella had acute pancreatitis and was hoptitalized for four days. I personally think that was brought on by a steroid shot she had been given 3 weeks prior for a suspected allergy as her blood was just tested and she was healthy accross the board. Has anyone had luck controlling or getting diabetes into remission with a cat who has had acute pancreatitis?
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Not sure if this makes a difference or not but I recently found out that Ella was at 113 three weeks prior to her bout with pancreatitis. Perhaps being in the blues are her normal range or perhaps she was beginning to develop diabetes? Not even sure if those numbers matter but thought I'd share.
 
Re: 03/31/12 Ella AMPS 221 feeding/bouncing question

Many cats here have had bouts of pancreatitis or one acute episode that probably contributed to their developing diabetes. If you look at people's signatures or ot the very beginning of their spreadsheets, you'll often see a note about medical issues.
 
PMPS 412. So am I correct when thinking that it doesn't look like she bounced so far today?

She seemed like she surferd in the pinks today.
 
mia - what a wonderful post about how Kitty transitioned over to canned low carb food! thanks for sharing it.

steroids can bring on diabetes, but as i understand it, those cats are often OTJ relatively quickly.

i think i understand your question about bouncing now - you're thinking our goal is to have kitties flatten out their cycle. that is true, but the primary goal is focused upon getting the cat's bg back into the normal range. some cats don't really bounce much. that's why we continue the conversation about the canned food with you.

it's hard to answer you about the high numbers tonight. it could be a bounce from the 191 this morning, it could also be from the dry food eaten today.

because we've seen how ella dropped so quickly with just the snack change, i think the consensus was to have you switch all at once rather than trying to gradually reducing the dry food and increasing the canned food.

how would you like to transition, tamara? i can't help but think that this is causing you a lot of stress and you will see such an immediate improvement that the change is not only going to help ella, it's going to help you. none of us has a crystal ball to know the exact way to do this. you could even skip a shot at the same time that you change the food in order to help you not be so worried. a cat can't become hypoglycemic without injected insulin. as you get the numbers we can help you decide on the next doses, just like we did with mia.

when was that steroid shot given?
 
just to be really clear - we don't want to see any cat surfing in high numbers. the more hours spent under 200, preferably between 50-100, the better for the cat.
 
Hi Tamara!
Kitty was diagnosed with diabetes in December when I took him to a vet after he had had weeks of excessive drinking and peeing. His fur was dull and he also had lost weight, which I had not noticed so clearly. Thus, I think Kitty's diabetes had developed from the bad diet and being overweight - dry food only for his whole life.

As for many (most) of us, the diagnosis was a shock even though I had suspected it. The Russian vet gave me Caninsulin to start with. As you can imagine, I started internet search on what to do, and learned about Lantus. I got Lantus prescription from my vet at home during Christmas break. Even though I had read about the benefits to switch to wet food only, I did not start trying to transition until about mid February. Early Feb I first switched from Caninsulin to Lantus, and after that the diet change, and seems that it was the right thing not to do diet change at the same time. Hindsight - I should have first in December changed the diet after the diagnoses and start with low dose on Lantus. If any newbie is reading this message, please do it this way and please pass on the message.

I hope my and Kitty's story on changing from dry to wet food will make others feel comfortable about the change. I am working very long hours and during the diet transition I was away from home many days, so there was no continous testing (not ideal of course, but happens in real life ;-) ). When I was at home during the weekends, I was though obsessed with testing as you can see from our spreadsheet. The effects of the transition will be different for each cat, but as in Kitty's case the improvements were very fast, which means that you may need to adjust the dosing frequently - but as said, I did this even with long working days and travelling. Skipping a shot or two did not cause issues in Kitty's case, so that is always an alternative if you are afraid of going too low and you are not at home to monitor.

As Julie is writing, the aim is to keep Ella in the greens as much of the day as possible. That logic was not so clear to me when Kitty was still eating dry food and he had continous pinks in his curves. After the wet food and lowered dosing, the green surfing felt just wonderful. :mrgreen:

Now when we are heading for the permanent OTJ period (keep your fingers and paws crossed!), I am pretty relaxed how my two cats live their lives. They have always had food available, which still continues. It's just that it should be LC wet food and absolute NO-NO for any dry food. We do not have a feeder, at least not yet, and will have to see if we make this adjustment a bit later on.

Please feel free to share our story with anyone wondering about the diet transitioning or what happens when numbers start to fall or how to manage dosing when you are not at home for days. Kitty's story may end up exactly as it should (still not declaring victory (OTJ) too early :cool: ), and for sure it has been an amazing learning journey with all wonderful people at LL!
 
Hi Julie,

Thanks for your post. The steroid shot was given at the end of November last year. I realize that we don't want the cat to surf at really high numbers...I guess I used the wrong word to describe that she was riding pink all day:)
It sounds like transitioning all at once seems like the way to go. I guess I should give her some wet this week, to get her accustomed to the switch so it's not a total shock to her system.
 
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