04/25 Skipper AMPS 'Hi'

[millerb]

Hello all. I haven't checked in in a while, mostly because of my job and other commitments I am unable to keep up with a daily forum. But I wanted to provide an update on Skipper for those who were so helpful to us.

Essentially, nothing has changed. His BG is all over the place, however, he is eating better, gaining weight and keeping it on, drinking and peeing less, and seems the same as usual behavior-wise. I did an hourly, 16-hour curve at home April 14, and it really didn't yield any clues or help, just more confusion. We have had weekly phone check-ins with the internal medicine specialist, and saw her last week. Next month we will do some bloodwork to see where things are with his anemia, kidney disease and hyperthyroid.

I have not been able to transition him to wet food. I've tried everything and every kind of low-carb and mod-carb food I can find, and have thrown out many, many cans of food. I am on a temporary hiatus until I can think of some other way.

We have had several hypoglycemic episodes but they have been very short-lived, thankfully.

I'm starting to resign myself to the fact that we may never see improvements in his BG numbers, but that if his symptoms are better, then that's at least something.

 

[julie & punkin (ga)]

aw, beth, i'm sorry you're having such a hard time. i looked at his spreadsheet and he is all over the place. it's no doubt a combination of factors - what he's eating would make a difference. if you can't get him transitioned off the dry food, it *might* be better to just be consistent every day with the dry food so he has the same carbs all the time, then you might be able to get him a little better numbers with dose adjustments.

the Start Low Go Slow is probably the best choice to follow for dosing. you don't want to try to follow the TR protocol with dry food in the picture. the link for SLGS is under the Tight Reg sticky as well.

just a reminder that the mid-cycle checks will tell you how low skipper is going. when you see a 33 at amps, you have to consider how low he may have gotten in the night before that test. that thought frightens me. it's better for him to be too high than to be in these kind of low numbers.

 

[millerb]

Thank you, Julie.
The dosing method we're using right now is this:
BG 300-Hi: 3 units
BG 200-299: 2 units
BG 100-100: 1 unit
BG 50-100: 1/4-1/2 unit

We've tried different dosages and just giving 3 units once a day, and nothing really seems to change. I am just feeding him the dry food right now (Purina DM, which is supposed to be low-carb, but I know it's really not) and not even trying the wet food. The problem is, he knows the dry food is there, so when I put wet food in his dish, he walks over to the dry food container and sits there staring at it. I'd rather he eat something than nothing at all, so I give in. I'm afraid to let him go without food since he has had so many hypo episodes in the past few weeks. So I'm probably contributing to the problem, but I feel like I'm out of options.

 

[julie & punkin (ga)]

i think it would help you a lot to understand how lantus works. the dosing schedule you're describing works for the older insulins that do not build up in the body. even prozinc can work on on a sliding scale. with those, you see a preshot number, you refer to your scale for a dose, and shoot it. the insulin goes in and in a matter of hours it has done its thing on the carbs, the BG has lowered, and all is done.

The newer insulins, Lantus and Levemir both work as a depot insulin. they build up in the body and slow release. you can see action for literally days after a dose because of that slower action. it also means that it doesn't "yank" numbers down in the same way that the older insulins did. you simply won't find success with skipper using a sliding scale with lantus. it just doesn't work that way - and that's likely contributing to your wonky numbers.

you sound really discouraged - and i don't blame you. you've got numbers & doses all over the place.

i think you've got a couple of options. if you can ditch the dry food entirely (and that means out of the house) and get him transitioned entirely to canned food, you can consider the TR protocol. but you can't have it around to tempt skipper - that's like having crack around an addict. there are some cats that are so carb sensitive that even a couple of kibble pieces will affect their BG for hours afterwards.

if you can't transition to only canned food, then go with the SLGS plan.

here are the guidelines for Start Low Go Slow.

either way is ok, but the one thing that's not going to improve things is to continue using a sliding scale. Lantus needs consistency in dosing - same dose, roughly 12 hrs apart as much as possible.

btw, "low numbers" are anything below 50. non-diabetic cats often test in the 40's - that's not necessarily hypoglycemic - but i think all of us would agree that you want a plan that's not having skipper show up on a morning test at 33. that's far too risky.

we'll help you in whatever you decide, but i feel pretty confident that you're going to get better results only if you change your plan.

 

[millerb]

Thank you SO much, Julie. I am very discouraged. I will study the Start Low Go Slow document tonight and see if I can implement that. From what I understand, I start with 1 or 2 units (I would feel more comfortable with 2) twice a day, then after a week or two, modify that based on the lowest point of his curve. Is that correct? Also, can you explain what a rebound is? Is that what's happening when he goes from a very low BG reading in the morning to a very high one in the evening?

I've already tried every brand of low- and mod-carb canned food out there and feel like I'm tossing dollar bills down the garbage disposal every day. Thankfully I found a cheaper source for Lactated Ringer's than my vet, so that's going to be a huge help on the budget going forward.

 

[julie & punkin (ga)]

the starting guidelines are for someone who hasn't been on insulin yet. since skipper's already been on, we would take into account what his current dose is.

you're going to want to get his food carbs as stable and consistent as possible. Evo kitten is the lowest of the dry foods, if he will eat that. i think it's 8%. so giving him the same volume of carbs at the same times of the day if you can, will help in this process.

for example, if you set out a combination of wet and dry, measure each, mix them up, and set out the same amount with the shot morning and evening. do you just feed twice a day and let him graze, or does he eat more often? most cats will do well with most of their calories (and therefore carbs) within the first half of the cycle. so we usually minimize the carbs after +5 or +6 until the next shot time - this depends on the cat. some cats seem to benefit from a tiny snack at +9 or +10.

he has to eat - of course - so whatever he'll eat is what we'll work with. if you can't get him to eat the canned, then stay with the dry and we'll give insulin to compensate.

you're going to really have to work to get rid of thinking like you did when you gave him prozinc. dosing guidelines are based on that lowest point of the cycle, so you've got to get some mid-cycle tests in there so you know how low he's going.

Looking at his spreadsheet, i think i would go with 2 units. it's on the higher end of the SLGS starting dose, but the dry food carbs require more insulin to work. then sit on your hands in regards to the dose. test before shot, but unless it's say less than 150, don't change the dose. if you see a lower than you expect preshot, post here and ask for immediate help. you're going to want to remind anyone giving you dose advice that you are following SLGS. it would be a good idea to put it in your signature line. if you see a high preshot, you still stay with the 2 units. then the dose is evaluated every week or so after a curve.

have you looked at http://www.catinfo.org for tips on transitioning with the food? if not, that's got great ideas.

rebound or a bounce, is what happens when the liver reacts and puts out stored sugars and hormones to pull up the cat's blood sugar. here's a link with 2 parts - the first post by jill is about New Dose Wonkiness, which you are seeing some of all the time, and then farther down i added a description of what happens to cause a bounce. you are definitely seeing some bouncing too. those red/black numbers are probably bouncing from low numbers that we aren't seeing.

take a look at these and see if you have questions.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012

we'll get skipper there! slow and steady wins the race with FD! hang in there.