09/27 Pickle | AMPS 422 | Newly Diagnosed, Need Dosing Advice Please! | Feline Diabetes Message Board - FDMB

09/27 Pickle | AMPS 422 | Newly Diagnosed, Need Dosing Advice Please!

K + P

K + P

New Member
Hello, everyone. This is my first post. I'm thankful for finding this website & forum and for all the information on it. I've already learned so much!

My buddy Pickle was diagnosed Sept 05, Vet prescribed Senvelgo initially, which I never started. Over the Sept 06-07 weekened, I did an insane amount of research, I found this site, and started to prepare us for this thing. I tested his ketones at home with a urine test strip, It came back trace. (Diagnosis Labs Ketones were NEG) Went to Vet Mon. Sept 08 and had a blood ketone test that was a little high, Which is when I made the decision to go with insulin, though Dr was still suggesting Senvelgo w/ Ketones. I said nope! We started 1u Lantus (Sept 09 PM) w/ a recheck in 2 weeks for dosing adjustment. Had our appt. 09/24 and Dr wants to go up to 2u, which I feel nervous about. I kind of like the idea of following the SLGS method here, but I feel bad/nervous about going against Dr's orders.

I'd love some advice please about dosing, is 2u okay based off our numbers so far? should I try 1.5? or should I just follow SLGS. I have some data on our SS, though we've taken a bit of a breather the past couple days after our big curves. Also, how should I handle the Dr? I suppose I just tell him I feel more comfortable going slowly. He's been great about us home testing and stuff so far. Though he is younger and I'm not sure he's fully educated on FDM. Ugh, idk. So much going through my head lately.

Thank you all for everything!
 
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You came to the right place! And you're so smart and motivated, and questioning in all the right ways.
You'll get great advice here. Just saying hi, and also bravo for doing the best thing for your very cute Pickle!

And many, many vets are pretty clueless about FD. You'll likely end up educating yours.
 
Thanks Lara for saying hi! And for the kind encouraging words.

I should also add some info and how he's feeling overall. He's been a kibble head his whole life (Because that's what my uneducated self was giving him). At diagnosis we cold turkey switched to FF Classic pate which he absolutely loves and has adapted to so quickly thankfully! As if he was saying "Why the heck haven't I been getting this always!" Leading up to and at diagnosis, he had lost a lot of weight, skinny around the hind legs + hips + spine area, excessive drinking and urination, very hungry, very tired, no interest in play, isolating more. He lost his spark.

After starting our 1u, he almost immediately started drinking & peeing less frequently (from 8-10/day to ~4/day). After about 5 days of sleepiness, he's been progressively gaining more energy and his always playful spirit is returning! He's also not feeling so bone skinny. He's still been a hungry boy, but I think his diet is in a decent spot at the moment. I'm keeping an eye on all that pretty closely.

So he's feeling better, which makes me feel his dose isn't super far off I hope! And he's had some numbers around & under 200, which I know around here, dosing is based off low numbers, And I got the feeling the Dr. was basing dosing off high numbers, because that was his focus, at least verbally to me. Also, to my unexperienced eyes, I think Pickle may be bouncing? This is where I just don't have the knowledge to know what to do and I would appreciate some experienced guidance and input!
 
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Keep your spreadsheet up to date so the wise guides here can give you dosing advice to follow.

You're doing amazing by setting up a spreadsheet. It makes it so much easier to track how 🥒 is actually doing.

And you're right that dosing goes by the nadir, which is the point where the insulin is at its most effective, and the cat's blood glucose # is the lowest. For many cats on Latus, that's around +6ish, but a universal truth is Every Cat is Different (ECID) 😄

With testing, make sure you get a test at +2, so you can see where the 12-hour cycle is going to take him. He might dive quickly, and have some surprises in store for you. Be sure to get a nadir reading, which could be the +6 or earlier or later. Be sure to do the same, as much as possible, for the PM cycle. Cats often go low at night.

Give small meals throughout the day, if you can. So after breakfast, 2 tsp of low carb food at +2 and +4, if you're able. This can help keep Pickle from going way high and way low. It's all about getting that BG curve gradually flattened, and getting him in healing #s, where his pancreas might kick in and head him to remission.
 
Hi K and Pickle!

Welcome to the forum!

You'll get someone to pop by with dosing advice soon (I'm not qualified to give dosing advice), but one thing I'll mention is this: we typically increase/decrease Lantus in .25 unit increments. So, you can still follow your doctor's advice to increase, but do it following the SLGS schedule in .25 unit increments rather than one entire unit at once. I'm sure you've read this, but just in case, here are the two dosing methods with increase/decrease guidelines: Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR).

Also, I notice you're not posting any PM tests. Is there a reason for that? You always want to try to get at least one other test per cycle, in addition to the preshot test. It's really important to see how he is handling the insulin in the PM cycle, to see, for example, if he is going too low, which could indicate a bounce in the AM cycle.

Lara mentioned nadirs; to illustrate the principle of ECID, Jude's nadir is typically at +3/+4.

I'm glad he's responded well to the food change and that he seems to be feeling better, overall.

Looking forward to seeing your little Pickle get better and better!
 
Mary & Jude said:
Hi K and Pickle!

Welcome to the forum!

You'll get someone to pop by with dosing advice soon (I'm not qualified to give dosing advice), but one thing I'll mention is this: we typically increase/decrease Lantus in .25 unit increments. So, you can still follow your doctor's advice to increase, but do it following the SLGS schedule in .25 unit increments rather than one entire unit at once. I'm sure you've read this, but just in case, here are the two dosing methods with increase/decrease guidelines: Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR).

Also, I notice you're not posting any PM tests. Is there a reason for that? You always want to try to get at least one other test per cycle, in addition to the preshot test. It's really important to see how he is handling the insulin in the PM cycle, to see, for example, if he is going too low, which could indicate a bounce in the AM cycle.

Lara mentioned nadirs; to illustrate the principle of ECID, Jude's nadir is typically at +3/+4.

I'm glad he's responded well to the food change and that he seems to be feeling better, overall.

Looking forward to seeing your little Pickle get better and better!
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Hi Mary, thanks for responding!

This has been a lot for him and I. For me mostly. He's handling it better than I am I think. It's all just so much to think about, and learn. In a way, I feel like this is up to me to figure out. I've been trying to ease us in to testing as best as I can and it's been going well but it's a balance. We've made big improvements to the ease and "quality" of testing I guess you'd say. I just have to maintain a delicacy with him. I don't want testing to become an issue. That's one of my biggest fears at the moment.

I will try my best to start filling in some gaps and get some P.M. numbers. But the PM number point brings up more questions and things to think about! And Laras point about meals and timing. I was looking at my notes and the numbers, and I think he was doing better when I was feeding him less, But I increased calories slightly because I was worried about ketones and weight loss, and he's been acting so hungry! Maybe I don't feel as confident about his diet as I did earlier. Agh! This is much.
 
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Cats act hungry - are hungry - when they're in high numbers. As you both ease into lower numbers, he won't act as hungry.

But if he's become bony, and you're feeding him low carb food, you can pretty much give him as much as he wants for now till he gets better regulated. Giving him additional small meals, rather than just 2 big meals a day, is great, and that's all I meant: additional small meals throughout the cycle are good.

Everybody worries about testing when they're new. I did too and felt like an axe-murderer. Cats get used to it really quickly, and often become very cooperative partners cos they know you're making them feel better.

You probably already know some testing tips but if you don't say so. There's plenty here about warming up the ear a bit, and where to aim for. As the cat gets more used to testing, the capillaries in the ear do too, and it all becomes just a routine part of the day. Of course lots of love and praise and a low carb treat are good too! I give Lu bonito flakes, and freeze-dried treats, of which there is a plethora.
 
K + P said:
Hi Mary, thanks for responding!

This has been a lot for him and I. For me mostly. He's handling it better than I am I think. It's all just so much to think about, and learn. In a way, I feel like this is up to me to figure out.
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It's SO MUCH! When Jude was first diagnosed and I started reading everything (and I was so thankful to have stumbled onto this forum full of information), I literally cried a few times because it was so overwhelming! And for most of us, our vets aren't super helpful; some don't know a lot about FD and don't understand the key points of testing, diet change, and dosing methodologies; also many don't understand that this is not a disease that you follow-up on every few weeks. It's an every single day, multiple times a day, full-time, round-the-clock-nurse situation sometimes. That's one reason this forum is so helpful. We're all living it, and if you're wondering about something, someone here has likely encountered it. AND there are people here who have lived it for years and are literal storehouses of knowledge.

You're doing so well! You're testing; you've engaged in a diet change; you're reading and informing yourself. Pickle is so lucky to have such a diligent mama.

I'm going to tag a couple of people since no one has weighed in yet on your dosing question: @Christie & Maverick @Sienne and Gabby (GA) @tiffmaxee
 
Mary & Jude said:
It's SO MUCH! When Jude was first diagnosed and I started reading everything (and I was so thankful to have stumbled onto this forum full of information), I literally cried a few times because it was so overwhelming! And for most of us, our vets aren't super helpful; some don't know a lot about FD and don't understand the key points of testing, diet change, and dosing methodologies; also many don't understand that this is not a disease that you follow-up on every few weeks. It's an every single day, multiple times a day, full-time, round-the-clock-nurse situation sometimes. That's one reason this forum is so helpful. We're all living it, and if you're wondering about something, someone here has likely encountered it. AND there are people here who have lived it for years and are literal storehouses of knowledge.

You're doing so well! You're testing; you've engaged in a diet change; you're reading and informing yourself. Pickle is so lucky to have such a diligent mama.

I'm going to tag a couple of people since no one has weighed in yet on your dosing question: @Christie & Maverick @Sienne and Gabby (GA) @tiffmaxee
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Thank you so much, Mary.
 
Hello and welcome to the forum :). A couple of things to consider. Since you’ve done a switch from dry food to low carb wet, that can often have a positive impact in how much insulin a cat needs, and indeed some kitties can end up not needing insulin at all, and are diet-controlled diabetic.

I agree with Mary and Lara, getting those spot checks at night are very important, since right now you are missing half the data. Ideally if you can get a before bed test at night, that will help to fill in missing pieces of the puzzle, since many kitties like to go lower at night. For a lot of cats on Lantus, if the +2 is lower than preshot, that tends to mean an active cycle, where additional tests would be helpful. If the +2 is higher, that usually signals that the cat isn’t going to be up to much action, and you don’t need to pay close attention to the cycle.

Pickle’s current patterns may very well be due to bouncing, which can happen when the cat drops too quickly, or hits numbers their body isn’t used to.

From the Basics sticky:

Bouncing - is simply a reaction to what the cat's system perceives as a BG value that is "too low". "too low" is relative. If a cat is used to BG in the 200s, 300s or higher for a long time, then even a BG of 150 can trigger a "bounce". Bouncing can also be triggered if the BG drops too low and/or too fast. The pancreas, then the liver release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream. *Usually* bounces clear within 3 days (6 cycles).

All that to say, based on where you are currently, and that you’ve held the starting dose of 1u for 18 days, and run a few curves during that time where nadirs have been over 150, you’d be fine to increase to 1.25u. I’d then suggest to hold this dose for 7 days unless Pickle gives you a number under 90, in which case you would reduce. As for BG testing, please do make sure to get each preshot, since you want to make sure it is safe to give insulin. We’ve had many kitties over the years who have thrown a low number at preshot that their caregiver did not expect.

I would then try and get a +2 each cycle (am and pm) and as I mentioned earlier, if that +2 is much lower than preshot, you’d probably want to keep an eye on the cycle, by getting at least another test somewhere between +3 to +5 or +6. The goal being to gather data to get a better understanding of how Pickle responds to insulin and carbs. Part of that process is to understand where he onsets, nadirs and how much duration he’s getting. Again, from the Basics sticky:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
My last thought (for now at least, since I’m afraid to overwhelm you ;)) is regarding feeding as much as the kitty wants; there’s some good information here:

Feed Kitty As Much As They Want?

Cute fella you have there! Please feel free to ask any questions, people here are always happy to lend a hand.
 
Welcome. Your instincts are right on! I’m glad you didn’t double the insulin dose, especially since you have wisely switched to a low carb diet. In time that can make a huge difference. Keep feeding h him as much as he wants. It’s good though at the beginning to pick up food 2 hours before giving insulin so that the preshot is not diet influenced. Cats do often drop lower at night but of course every cat is different. Keep reading and when you can look over our dosing methods. Keep asking questions too. The more the merrier.
 
Welcome to FDMB!

You have done a great job getting Pickles set up for success! The first several weeks of this journey are definitely overwhelming. We've all been there/done that. It truly does get easier.

One thing no one mentioned so far is treats. Treats help to provide a positive reinforcement for poking your cat in the ear. He'll begin to associate the pokes with something he really likes. Many members use freeze dried protein (e.g., chicken but it can be anything that is very low in carbs that your cat likes) as a treat. Some cats like to be brushed, have you sing to them, it doesn't matter. Whatever your cat views as a "treat" helps to build the positive association. There are also jerky style treats that are protein only.

I also think you were smart to to increase Pickles' dose to 2.0u. You are seeing nadirs that are below 200 and like you observed, your kitty is bouncing. While there are occasions when we've suggested a larger than usual increase, it would be 0.5u rather than the typical dose change in 0.25u increments. At this point, I think Christy's suggestion is on target. Stick with a dose change in 0.25u amounts. With SLGS, you'll want to evaluate the dose after a week unless the numbers drop below 90.
 
Appreciate everyone so much for your time and knowledgeable advice! And for the warm welcomes and kind words of encouragement !

I feel a bit more focused today. I did start the 1.25u, and I'm going to be doing my best to get those important tests, and do follow ups if the cycle looks active. Also redistribute his calories throughout the cycles better. I'm also going to keep in mind my suspicion on my calorie increase and the Feed Kitty As Much As They Want? post that Christie shared, which I'm very thankful for. I may try a calorie reduction after some time on this dose and before any future adjustments. We'll see how we go. 🤔

Thankul,
K + Pickle
 
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K + P said:
I may try a reduction after some time on this dose and before any future adjustments.
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Hi Mary! About making any changes to the amount of insulin Pickle gets, there's two different dosing methods: Start Low Go Slow, and Tight Regulation. A lot of us are using TR, but not everybody. I see you have SLGS on your spreadsheet. This is fine - you decide what works best for you.

You're really new to this, but a total champ about learning everything. So before you make any changes, add post another ? to your day's post, to get some experienced eyes on Pickles' numbers and whether he's ready.

For every day, post a new message, or condo, as they're also called in FDMB-speak, with a link to the previous day's condo, and edit the subject line to include Pickles' readings, as they happen.
 
Hey there! What I meant was a calorie reduction, I don't want to go willy nilly making dosing adjustments, Which is why i'm here! I did notice not many people using SLGS. I chose it because it seemed less intimidating for such a newbie like me. I know it's been over 3 weeks since dx but it feels like 3 days, and I just today made the decision to follow this site and not my vet., As things move along and I get a chance to learn more I may change. But yes, of course I look forward to my future posts and having updates and receiving feedback about future dosing. Thanks Lara!
 
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