1/1 Chianti amps 220 +5 44 +7 74 pmps 225 +4 252

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itzj

itzj

Member Since 2014
Thank you again for all the help last night. We learned a lot and this board kept me from total panic. I suspect we are now in the keep you on your toes part of this journey.

So am number was good. We did the dose drop by .25 and shot 3.75u.

Now I just need to try to understand what we do if he tests low again like last night. I am nervous to skip a shot and mess up his progress and nervous to shoot if he is low again.

I don't know how the rest of you do this calmly.
 
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We do this calmly because we've all had the experience of people holding our hand the first few times until we realized we can do this! It's why there are so many of us who stick around for so long -- some even after their cat has crossed the Bridge. There is a strong ethic of paying it forward.

If you get a pre-shot number that is lower than your comfort zone, please post and ask for help. Usually, there is someone around who can reply or will try to get hold of one of the experienced people who, if available, will help to walk you through the process. We really don't believe in one trial learning. It does take practice to feel comfortable steering the cycle with food and knowing how often to test. I'm a huge fan of getting a +2 or +3 test. If there is a big difference between your pre-shot number and the +2 or +3, you could be looking at an active cycle. If that's the case, you don't want to miss a dose reduction.

Am I correct in assuming you're using an AlphaTrack meter? If so, would you mind adding that information to your signature? It makes a difference in what numbers indicate a dose reduction.
 
No, we are using a relion. I fixed my profile. The first numbers on his chart are a alphatrak because the vet uses that. I saw the price and swiftly opted for a human meter.
 
+5 is 44

We are steering like we did last night.

But it looks like we are headed into a shot that we aren't going to know what to do.
 
ok, Chianti, that's low enough!

He really didn't even bounce from last night's green, did he? Very nice. It looks like it has been about an hour since the 44, have you tested again yet?
 
Just tested at +7 he was 74. I was sitting with him the whole time and he was purring and being super lovey.

I just have zero idea what we will do at his pm shot that is in 4 hours.
 
wow, i can't say how glad I am that you're getting these tests in. Great job handling all of this, Jenny! You're a trooper!

Not sure if you understand how Lantus works, so I'm just going to do some explaining. If you already know, ignore me, but just in case it's new to you . . . Lantus forms a deposit in the body and then sort of slow-releases. Think of timed release meds. When you increase the dose there is a delayed response before you see the full effect of the bigger dose. The depot has to increase to be in equilibrium with the new shot size. That's why we suggest holding a dose for a minimum of 6 cycles in most situations. 3 days lets you see what the new bigger dose will do.

When you decrease the dose, in the same way there is a delayed response until the depot is fully decreased and back in equilibrium with the size of the shot. So yesterday's 4.0u dose can influence as many as 6 of the next shot cycles. This is the first cycle after you reduced, so it definitely is still involved right now. As you get farther away from the previous dose of 4.0u it will have less influence on the blood sugar. Often when we see low numbers (under 50) in the first cycle after the dose reduction we would suggest holding the dose still at 3.75 because it's likely still from the 4.0u depot. Does that make sense? If the 44 had happened on cycle 4 after you'd reduced, we'd probably suggest you go ahead and take another reduction.

My only hesitation is that you've got a pretty good sized dose and it wasn't gotten to in the typical way. I'm not criticizing, just observing, that along the way the dosing increases were mostly based upon the preshots rather than the low points (nadirs) of the cycles.

Let's see how this cycle plays out and think about whether or not he should have another dose reduction this soon. You've got 4ish hours left before your shot time, i think. Can you check back in before you shoot at pmps?
 
I will most definitely check back in with his preshot test. I'm very, very nervous to dose him tonight.

Thank you for explaining that. I didn't realize how long one shot could still influence a cycle. Though that makes me scared of tonight since yesterday was the 4th day at 4 now that I get it a little better. Gosh I wish my vet got this. I mean she seems way better than most but hadn't even insisted that we preshot tested, but was happy that we are and wanted the dose bumped again. Am I likely to need to be really freaked out again tonight? Like is that 4th day going to ratchet the effect up even more?

So a question to try to get me to understand this all better (tired, homeschooling mom of 2 here, fuzzy mom brain is in full force). In general, if the nadirs stay at a good place, do the preshot values eventually, ideally, come down too, or is it just random whether the cat will remain with large swings or not? I've been trying to read a lot of threads but am having trouble finding time with the toddler's busy ways.
 
Hi Jenny - you sure have a lot on your hands with two kids and a diabetic cat. :bighug: However, you've got it spot on, as the cat gets more used to normal numbers, the bounces will reduce and you do start seeing the preshot values come down to be a lot closer to the nadir. Ideally if you shoot a lowish number, the cat stays flat all cycle. As an example, take a look at Remi's SS. He went OTJ just recently. Starting mid October, Remi decided he was mostly done with bouncing and Sarah had a lot of all green but flat cycles.

BTW: Great catch on that 44 today!
 
Yes, the more time a cat spends in green numbers, which typically come at the nadirs first, the more their body will accept it as normal and then you'll start seeing longer and longer stretches. As the cat stays in normal numbers (50-120 if on insulin on a human meter) the pancreas can heal and begin to produce its own insulin again. When that happens, we see the dose begin to decrease because the pancreas is supplementing what is being injected.

Typically the nadirs in the mid-cycle go to green first. Then the pmps often comes down into greens, and last the amps comes down. It's usually last probably because of Dawn Phenomenon. Cats experience that as well as people, which is why morning blood sugar is often the highest.

Libby's observation that Chianti didn't even bounce from last night and the fact that he's right back in green in the next cycle would suggest that probably, he's been seeing greens before now and his body isn't too unaccustomed to them.

As you could see from both your experience last night and again today, you are in control of his blood sugar and you are able to steer him with high carbs. You're doing great. :)

ps - i homeschooled 2 of my kids for one year, 5th & 8th grade - their schools were closing and consolidating and we opted out for that chaos-filled year. Then they both went back to regular school the next fall. It was a wonderful year with the 2 of them.
 
Ok this is starting to make sense. I wonder if those mornings he was in 300s he had self medicated with the chow/was bouncing a smidge. He hadn't been going near the chow until last week around midnight which would have been +5. And hasn't been eating much the past week (asking but refusing all flavors). But today and last night he gobbled food when we hit the lows.

Thank you for sharing Remi's ss. That really helps me to see what kind of a pattern we would like to see if he can manage to heal.

Feel free to school me. I do better with more information than less. :)
 
There's a lot to take in with FD and it makes the most sense when the info comes in context.

Are you saying that Chianti was eating dry food until recently? Does he still have access to it? Is that what you mean by chow?
 
He was diagnosed in September and we started feeding him only wet food, mostly fancy feast. But we have 11 indoor cats, some of which absolutely will not eat wet food and most are grazers. Logistically there is just no way to totally eliminate the chow so even though we offer wet to the rest 2x a day I have to leave some dry out. We switched the chow to wellness core so that if he made it to a bowl the consequences would be minimal. Up until last week he was not eating any chow that we can tell. Then last week he started getting finicky about flavors and eating less on top of it. I caught him eating chow in my room twice at night this week. We took him to the vet on Tuesday to make sure nothing else is going on to cause any appetite change beyond moving towards regulation.
 
ah, i see. that explains his higher dose. he's probably snitching little bits here and there - the lure of the dry food is pretty irresistible hahahaha. not to you and me, of course, but it sure is to cats. We have a member, Linda who had a similar situation. She had 13 cats and Scooter was diabetic. She was pretty sure that he wasn't getting any dry food because he didn't seem interested in it, but when she switched the whole household over to canned low carb, Scooter went from 5.5u to off of insulin in one and half extremely long days. It was so remarkable we saved her thread from that long day. If you're interested, it's in the Where Can I Find ____? post, look at the bottom in the "interesting posts" section under "dry food carbs."

it can be tough when you've got many cats like that. I have a friend (used to do cat rescue) who has 8 cats and some refuse to eat canned food, especially her 18 year old. You just do what you can. She's been trying to keep the dry food in a room that she lets the dry food eaters in and out of, while keeping her others out of that room. I (like everyone else) used to feed my cats dry food, but Felix had to have weight loss food and punkin had to have easy-on-the-bladder food. So I fed them in separate rooms twice a day and picked up the food when they were done eating. Not sure if that would work for you or not, but dry food eaters can learn to eat at mealtimes. Just a thought.

If you do something to change the situation and make it so that Chianti can't get dry food, then you'd definitely want to monitor extra and possibly decrease his dose in advance. dry food carbs can take a day or so to work out of the body.

In any case, Wendy & I had a chance to talk about the dose. We're both thinking that since you're following SLGS, you may want to go ahead and take another reduction of 0.25u. Under SLGS you reduce if the cat goes under 90. Under TR, you reduce if the cat goes under 50 - the tricky thing, as I said, is that it's very possible the dip today was from the previous dose. It's up to you.

You've had lots of stuff thrown at you in the past couple of days. What do you think you'd like to do, both with dose tonight and moving ahead?
 
The low carb dry foods are:
Evo Cat and Kitten - about 8% calories from carbohydrate
Young Again 0 Carb - 5% calories from carbohydrate as we calculate it, internet only
Epigen 90
Stella and Chewey's Freeze dried
 
Ok so we just tested and he is at 225. He had a little food (maybe a tablespoon or two max) of fancy feast about an hour and a half ago.

I am not sure what to do. I'm leaning towards reducing again to be safe if it will make any difference overnight. I mean I don't want to set him back in progress, but would it help him tonight to drop to 3.5 and then ease back up to the 3.75? Will it make any difference in the depot?
 
It's better to choose a dose and stick to it, ie, if you want to drop to 3.5u, go ahead and then if his numbers trend up, you can always go back up in another couple of days. I wouldn't see a benefit of going to 3.5u tonight and planning to go back to 3.75 in the morning, if that's what you mean.

Dry food is a complicating factor because it lasts so long in the body.

If you're thinking you want to try for remission, the dry food's gotta go or be switched to one of those low carb ones that BJM posted. There are some people who give those first two - the Evo kitten or Young Again. Is that something you want to try for?

I'm wondering about your plans for testing. Are you thinking you'll be able to get mid-cycle tests in now or is that still going to be difficult to get on a regular basis?
 
I was thinking more possibly dropping to 3.5 and holding it for a few days, get some nadir testing in and then go back up if needed since we screwed up and don't really know where he was falling on the 3.5. Do you think we've seen the worst of the 4u dose or could it get worse and deflating the depot a little larger would give a greater margin of safety? I'm afraid of making it worse. Though looking at his chart he made it through almost 2 weeks of 3.75 with no hypo attacks.

For midcycle, we are going to make every effort to get more testing in. The night tests will be easier than the days. I think we are both committed at this point to not do any dose tinkering without getting mid-cycle info in, even if that means we have to hold a dose until the weekend to test when we are both home.

I don't know that we can afford the prices on those other chows for 11 cats. I have to look at it more. Right now I just want to get a handle on this current predicament and see where we can get him on what we're on right now and then take it from there.
 
I am looking into the food, don't want you all to think I'm shoving it off. Just have to factor in children and the other animals we own too.
 
itzj said:
I was thinking more possibly dropping to 3.5 and holding it for a few days, get some nadir testing in and then go back up if needed
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Sure, that's all reasonable - about the food too. And don't feel like you screwed up, Jenny. If no one teaches you of the importance of catching how low the dose is taking the cat, how could you know? Vets mostly don't recommend home testing and if they only have experience with the older insulins, they also don't necessarily know about how important a mid-cycle test is. Don't beat yourself up at all. There is so much to learn with FD - just take the knowledge and move ahead with it. Everyone starts from whatever they know and then just plows ahead.

itzj said:
For midcycle, we are going to make every effort to get more testing in. The night tests will be easier than the days. I think we are both committed at this point to not do any dose tinkering without getting mid-cycle info in, even if that means we have to hold a dose until the weekend to test when we are both home.
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This is a great plan! Human nature is such that we often feel more in control when we understand more. Information helps so much - you learn what affects what and pretty soon, you have a good understanding of what's going on. That relieves so much anxiety and insecurity about how to move ahead. Also, night cycles are often the lowest numbers, so if you have to choose between a day mid-cycle and a night one, the night one is often more revealing of low numbers.

You're doing great, really. You've got your hands full and you're taking in a lot of new info. :bighug:
 
Ok. I think we are going to go with 3.5. Hold for 6 cycles. Test nadirs. Take him back up to 3.75 if testing warrants it.

Any major objections from anyone? Shooting in 5 minutes.
 
Oh sorry, the 3.5. I will go update now. That 44 today really freaked us out.
 
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