05/31 Nala AMPS 334, +6/ 85, +8/ 167, +10/223 Help pls

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rosannaf

rosannaf

Member Since 2011
Hello all:

I need some advice. My cat Nala (11yo) started Lantus about 2 weeks ago. The vet had originally wanted her to do 2u bid. Since my work hours are quite long and varied, we had decided to do 1u in the AM and then 2u PM. After speaking to a few members on the Main Board, they recommended I change the dosage to 1u bid since I am slowly transitioning her from her dry food to a low carb wet food (DM), and to get a glucometer.

I started taking BS readings on the 05/26/11 and slowly am transitioning her diet.

Today, Nala’s nadir was 85 at +6, which is the lowest I have gotten in the last week. I did wake her up from a deep sleep and the first measurement was 69(!) then I retested at 85. Her +8 was 167, +10 was 223. Am I doing anything wrong? Is this normal?

The only change I made to her food was that I left out less dry food for her to graze on. She’s always been a grazer and several members advised not to change her food so quickly when I’m starting her on Lantus. Since I have three cats total (only Nala is diabetic), I use to leave out 1 cup dry Nuto Max WC at morning and night. Nala is eating ½ can of the 5.5oz DM wet in the morning and night. I am slowly changing the dry food to Wellness Core for my other cats who are not taking to any wet food. I was leaving out ¾ cup Nutro and ¼ cup Wellness mixed together 2x/day. Last night, I changed it to just leaving out ¾ cup of the dry food and this morning I kept it at ¾ cup dry and I’m not sure that’s why her nadir was low today. Should I change it back to 1 cup dry in the morning and night until I get more consistent results?

Thank you in advance,

Rosanna
 
Welcome Roseanna!

It sounds like you've already gotten some good advice along with having your SS up and running!

Since the nadir is the lowest point of the cycle and your nadir was in very good, normal blood glucose (BG) numbers, this is not only good, it's great! Right now, what you're seeing is that Nala isn't quite used to being in those blue and green ranges. As a result, her liver overreacts and she bounces back up into higher BG ranges. As she gets used to spending more and more time in lower numbers, the curve will flatten out.

If you are still feeding the Nutro, at least with one cat food calculator, you've been feeding Nala dry food that's roughly 37% carb. Needless to say, this isn't helping to keep her numbers down. Wellness Core is 11% carb. If you have to feed dry, you'd be much better off feeding Evo Cat & Kitten dry (8% carb). However, I'd encourage you to read Lisa Pierson, DVM's website on feline nutrition. Fundamentally, cats are obligate carnivores and dry food is not particularly good for them. Also, if you are feeding DM, I'd encourage you to read the label. It's primarily animal by-products. Even Fancy Feast is a better quality canned food than DM. You could be feeding a high quality, human grade canned food for less than what you are paying for prescription food.Ideally, you want Nala off of all of the dry food altogether.

Could you say a little more about your schedule? It sounds like it's challenging and it may help us to puzzle through your question about feeding.

In the meantime, you may want to read the starred sticky notes at the top of the Board. Below is an outline of the information they contain.

  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
 
Thank you very much Sienne and Gabby for your time and excellent advice!

Since I am only a few weeks into my SS, I’m still not very comfortable with what to expect from Nala’s curve. What is considered a “normal” nadir? When should I get worried – is there a particular number (<40?) or when Nala exhibits signs of hypoglycemia?

Will the curve flatten itself over time? Should I consider changing the dosage at this time or wait at least a week or two? Since I’m still changing her diet to hopefully all wet eventually, I’m really scared about making so many changes at one time.

The wet DM was a suggestion from my vet the first time Nala was diagnosed. Since I did not find this board at this time, I started her on DM without reading the article about how FF Classic wet was a good option. Since Nala actually likes the wet DM, I decided to have her stay on it for now. I did purchase some FF Classic wet food for my other two cats – who absolutely do not like the wet food. Since I still have some FF, I’m going to slowly transition Nala from her wet DM to wet FF after reading your post. I’m just worried since it’s been only a few weeks since she’s been diagnosed and I still don’t feel 100% secure of my decisions sometimes.

Also, I feel more secure knowing she has some dry food to graze on when my husband and I are not here. Since she’s been on dry Nutro for so long, I’m slowly transitioning to dry Wellness Core to graze on a bit (I'm leaving out about 1/4-1/3 cup in the AM and PM for her to graze on, I also have 2 other cats that I'm trying to feed separately). I had looked into the EVO 95% but it was a bit more difficult for me to find a store that carries it. The Wellness Core is sold in a Petco around the corner from my office and I had read some positive reviews about it. I will definitely consider the dry EVO 95% in the future once I get a more stable diet plan worked out and if I'm unable to change my other cats' diets to wet food.

My work schedule varies from week to week. I alternate between working either 4 days/week or 6 days/week. Since I’m on-call, I sometimes can work 8+days in a row before a break. My schedule usually is waking up around 6AM, feeding the cats around 6:15AM, doing her BS reading, and then doing her insulin shot around 6:30AM. I typically will leave the house around 9:45 or 10:45AM. I do not return home until 6:30-7:30PM. My husband is usually at work from 6AM – 6PM, so Nala can be left alone for 8+ hours a day. I’m fine doing her AMPS and PMPS readings, but I can’t easily do a +6 reading unless it’s on a rare day I have off. My husband is not a pet-person himself but respects my relationship with them. He is unable to help me feed the cats, take any BS readings, or inject the insulin since the cats have always hid from him.

Any suggestions would be greatly appreciated. I did look through all the links you had provided – thank you again!

Rosanna
 
Let me suggest a slight modification in what order you're doing things. Most of us test first, then feed, and then shoot. If you feed before you test, there's always the possibility that the test will be influenced by food. If you get a low number at a pre-shot test, you may need to hold off on feeding and stall until BG levels rise. (You'll see info about this in the Data Ready sticky.)

I don't know that there's a "normal" nadir. We look to getting our cats' cycles in normal BG numbers (i.e., under 120). As noted in the Tight Regulation sticky, in order for a cat to earn a dose reduction, numbers need to drop below 50 (in a cat within a year of diagnosis). Gabby, for example, has dropped below 40 and even below 30 with no symptoms of hypoglycemia. There is a difference between a cat experiencing low numbers and a cat that is experiencing symptomatic hypoglycemia. We manage low numbers (and even hypo symptoms) by using high carb canned food and/or syrup. We don't encourage hypo symptoms but we do want cats to spend as much time in safe, green numbers in order for their pancreas to heal and for their bodies to become reacquainted with being in lower number ranges.

Rather than leave dry food out, you can leave canned food out. If you mix the food with water, it will hold for several hours. Many of us use timed feeders to dispense food when we're not home. Another alternative is to mix canned food with water until it's soupy and then freeze it in ice cube trays (i.e., catsickles). You can leave a few out and fresh food with then be available. Many of us work and our cats are home alone for the better part of the day. It looks like you'll be able to get several tests before you leave in the AM. If Nala's numbers are running low, you'll be able to leave out higher carb food to offset any drop in numbers.
 
Hi again Sienne and Gabby:

I will start testing Nala before feeding her. I never thought of it before, but it makes perfect sense to check before I start feeding in case that may affect her numbers.

Thank you for the idea of leaving canned food out with a timed feeder and possibly making catsicles. How much food should I be feeding Nala at this time? She used to be around 15 lbs, and now she is about to be 12 lbs. I’m feeding her 1/2 can wet DM 5.5oz in the AM and PM (and leaving her the dry food to graze). Is she supposed to be eating more or less? If I do leave wet food out, how much should I leave out? A few tablespoons? A few catsicle cubes?

Thank you again for all your help!

Rosanna
 
How much you feed depends on whether this is a good weight for Nala. This is a formula from Dr. Lisa's site for calculating calories per day:

Required calories per day = [13.6 X optimal lean body weight in pounds] + 70​
Janet & Binky's list will give you the amount of calories in the food you're feeding (or it may be on the manufacturer's website). Note that Dr. Lisa has indicated that this formula is generous. So you may need to adjust it if you see that Nala is gaining more weight than you'd like.
 
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