? 10/07 Mai AMPS 598, +2 490, +4 372 +6 343 +8 343 +10 343 PMPS 282 +2 271 +4 152 (NEW Member)

[Mai & Dad]

Hello everyone,

I want to first quickly introduce myself as Mai's dad. Mai is a 11 year old male Siamese, who had been with me since I moved to the US for college. Long story short, he was the only one who is always there for me through the last decade, when I first came to a foreign country alone and when I fought through my PhD program. It is an understatement to say he is a significant part of my life.

We are new to the LBL family so I thank you in advance for reading this long post.

A bit more relevant background: we had a rough year in 2023.

• He was officially diagnosed late September / early October.
• He spent 4 days in the ED and 17 days in the ICU and had two DKAs in the hospital.
• Repeated visits to curve at different vets led to little results. He was never really well regulated.
• I started using Free Libre II but still struggled to get him under control.
• He had been on 4.5 units Lantus for a few months.
• He is now on 5.25 units for 4 days. Planning on trying the TR method going forward.

Question on LC diet resulting in higher glucose:

• The last change I did was switching him to LC food. He was on Glycobalance Rx, which has 14% carb DMB. His new food is either 0% or 4% depending on flavor.
• I put a Free Libre on him on 09/26, two weeks after he was 100% on his new LC food.

His recent curve before Premier Blue:

• We observed high flat curves for 3-4 days in a row. My vet asked me to change his dosage from 4.5u to 6u. After reading on this forum for a year, I was worried that would be too much. So I switched to 5u first for 2-3 days (with nadir in ~350 and only 1 nadir per 24 hour cycle)
• I then switched him to 5.25u, which is his current dosage. He has been on this dosage for about 4 to 5 days.

Premier Blu results and questions:

• I am now testing him at home starting from 10/06 late PM. All results are updated in his sheet.
• How long do you think he needs to be tested every two hours? To be honest I have been exhausted and worried about him for a week now and testing both nadir and every two hours require me to stay awake for quite long...
• Why do you think he had high flat curves after switching to LC food? Shouldn't his glucose drop as a result? And I only began testing his curve 2 weeks after he is on his new food so bounces should no longer be an issue?
• I was really clumsy yesterday and gave him multiple bruise. Now I aim for the sweet spot and press his ear for 20 seconds afterwards. But there are still basically bruises all over his sweet spots on both ears. Can I still testing him? Will I give him hematoma?
• Given his current results, should I adjust his dosage or wait for one more day?
• And please let me know if you have any other thoughts or suggestions. After a year of getting no where, I am getting worried and frustrated. I really do hope the TR method will work.

Any help would be truly, and greatly appreciated! Thank you!

Hao

 

[Bandit's Mom]

Hi and welcome to the LBL forum!

I'm linking your previous post on the Welcome/Main forum for continuity:
https://www.felinediabetes.com/FDMB...-lc-pls-help-with-slgs-vs-tr-and-diet.294702/

How long do you think he needs to be tested every two hours? To be honest I have been exhausted and worried about him for a week now and testing both nadir and every two hours require me to stay awake for quite long...

We like to suggest getting a +2 because it can act a lot like a crystal ball in what the rest of the cycle is going to look like.

• If the +2 is about the same as the PS, it's usually going to be a pretty normal cycle - gradually down to nadir and then gradually back up to the next PS.
• If the +2 is a lot higher than the PS, that usually means there's a bounce starting and it's usually OK to take a little bit of a break from testing.
• If the +2 is (a lot) lower than the PS, that's your early warning that it could be an "active" cycle and numbers might go a lot lower later in the cycle and it's important to try to get more tests.

Of course, some cats have an onset later in the cycle like +2.5 or +3. In that case, a test at +2.5 or +3 would be a better indicator than a +2.

On the night of 10/6, he has a flatter, typical Lantus cycle so you could have stopped testing at +4. Last night, he was clearing the bounce and hence the additional downward momentum and later nadir. What is his feeding schedule like?

Btw, did he not get insulin yesterday morning? The SS shows 0 units in the morning. For cats with a history of ketones/DKA, you do not want to skip insulin.

Why do you think he had high flat curves after switching to LC food? Shouldn't his glucose drop as a result? And I only began testing his curve 2 weeks after he is on his new food so bounces should no longer be an issue?

Bouncing is not related to food but to lower numbers. Although feeding carbs can contribute to the bouncing. Bouncing reduces as a cat's body gets used to lower numbers. Bouncing is also caused by sharp drops which is why we use food to reduce the diving and the consequent bouncing. See this:
Using Food to Manipulate the Curve

I was really clumsy yesterday and gave him multiple bruise. Now I aim for the sweet spot and press his ear for 20 seconds afterwards. But there are still basically bruises all over his sweet spots on both ears. Can I still testing him? Will I give him hematoma?

Can you share a pic? Are you using a lancing device or poking freehand? Do you reuse lancets?

Ear Care
Since our kitties must endure so many tests, what are some ways to take care of the ears?

• Hold a wet, cool baby washcloth on the poke site immediately after the test to prevent bruising.

• Put Emla cream on the test sites after each test. It only takes a tiny dab and you can wipe it off before the next test. Emla cream requires a prescription from your vet. Neosporin with has been found to contain a toxin to cats, polymixin, and should be avoided.

• You can purchase Ledum 30C homeopathic remedy at any health food store. Dissolve one tablet in a small bottle of pure water and then apply one or two drops to each ear every day. Ledum is great for puncture wounds.

Given his current results, should I adjust his dosage or wait for one more day?

Could you please update the SS with the dose info from 10/1? That is, add rows from 10/1 to 10/5 and fill in the Units cell?

Do you always feed your kitty a treat after each testing. But if I test him every two hours everyday, wouldn't that result in a lot of treats for him?

You don't have to. What treats are you giving him?

And could you please refer me to a few posts about diet for diabetic cats? My cat had elevated kidney number for a few years now. I am slightly concerned switching to such a high protein diet might push his kidney further to the edge. And I wonder what our members do under such circumstances? I want to feed him ultra-low phosphorous food but those only come with kidney rx and the few options are all low in protein and high in carb.

What stage CKD is he at?

Many vets jump to "prescription" food even when there's really no need – both with diabetes and CKD. The only time a cat might need K/D is when they're in stage 4 or end stage CKD. Otherwise, you want to feed foods that are both low carb (for the diabetes) and low phosphorus (for the CKD). It used to be thought that a low protein diet is beneficial for cats with kidney disease but newer research shows that it's much more important to restrict phosphorus. That restricting protein at low levels of CKD just leads to muscle wasting.

Look into canned foods by Weruva. They have a large variety of flavours that are both low carb and low phosphorus. And they put their nutritional information on their website for every single one!
Look for foods with carbs under 10% and the dry matter for phosphorus under 250mg. Treating the diabetes will in turn help the kidney disease by reducing the strain on the kidneys that diabetes causes.

 

[Mai & Dad]

Hi and welcome to the LBL forum!

I'm linking your previous post on the Welcome/Main forum for continuity:
https://www.felinediabetes.com/FDMB...-lc-pls-help-with-slgs-vs-tr-and-diet.294702/


We like to suggest getting a +2 because it can act a lot like a crystal ball in what the rest of the cycle is going to look like. If the +2 is about the same as the PS, it's usually going to be a pretty normal cycle - gradually down to nadir and then gradually back up to the next PS.

• If the +2 is a lot higher than the PS, that usually means there's a bounce starting and it's usually OK to take a little bit of a break from testing.
• If the +2 is (a lot) lower than the PS, that's your early warning that it could be an "active" cycle and numbers might go a lot lower later in the cycle and it's important to try to get more tests.

Of course, some cats have an onset later in the cycle like +2.5 or +3. In that case, a test at +2.5 or +3 would be a better indicator than a +2.

- Thank you for the detailed information. It makes sense and I will try to test him more frequently since we really just got started on TR.

On the night of 10/6, he has a flatter, typical Lantus cycle so you could have stopped testing at +4. Last night, he was clearing the bounce and hence the additional downward momentum and later nadir. What is his feeding schedule like?

- He eats his two main meal right before the insulin shot at 930am and 930pm (CT). He typically eats for 10-15 minutes and I will give him his shot right way (945 ~ 950 ish). I was feeding him 1 can of Tiki Silver Chicken (0.487% carb DMB and 0.9 phosphorous) and 1 can of Tiki Cat Luau (0-4.7% carb depending on flavor and 1.0 - 1.1 phosphorous).
- In the last 5 days, I reduced his main meal from 2 cans to 1 can of Tiki Silver and ~0.6 can of Tiki Cat Luau.
- He gets one Inaba Churu (hairball control version) mixed with prebiotics and psyllium husk morning at night around +2 or +3.
- He gets to scrap the plate of my other cats around +4, which typically leave him a couple of small bites.

Btw, did he not get insulin yesterday morning? The SS shows 0 units in the morning. For cats with a history of ketones/DKA, you do not want to skip insulin.

- He did! He got 5.25.
- I try my very best to shoot sharply between 945 and 950 and not give a fur shot. But I have heard very mixed opinions on this for cats with DKA history. Many say skipping one won't hurt typically, and many think that need to be avoided at all cost? Do you have a take on this?

Bouncing is not related to food but to lower numbers. Although feeding carbs can contribute to the bouncing. Bouncing reduces as a cat's body gets used to lower numbers. Bouncing is also caused by sharp drops which is why we use food to reduce the diving and the consequent bouncing. See this:
Using Food to Manipulate the Curve

- Thank you! I was trying to say his flat high from 09/26 to 09/30 should probably not be bounces since nothing changed in the two weeks leading to that in terms of bounces. I was trying to figure out why switching to LC food resulted in high curves if bouncing is not a likely possibility.

Can you share a pic? Are you using a lancing device or poking freehand? Do you reuse lancets?

- Left ear pic and right ear pic. Thanks for checking on the graph!
- I am using the ReliOn Lancing device with its transparent cap.
- I do not reuse lancets. Even if I poke and see no blood, I would change to a new lancet.

Ear Care

Since our kitties must endure so many tests, what are some ways to take care of the ears?

• Hold a wet, cool baby washcloth on the poke site immediately after the test to prevent bruising.

• Put Emla cream on the test sites after each test. It only takes a tiny dab and you can wipe it off before the next test. Emla cream requires a prescription from your vet. Neosporin with has been found to contain a toxin to cats, polymixin, and should be avoided.

• You can purchase Ledum 30C homeopathic remedy at any health food store. Dissolve one tablet in a small bottle of pure water and then apply one or two drops to each ear every day. Ledum is great for puncture wounds.

- Thank you! I will get some Emla cream for him asap and get the Ledum today.

Could you please update the SS with the dose info from 10/1? That is, add rows from 10/1 to 10/5 and fill in the Units cell?

- I just did! He was on 5 units between 10/01 and 10/02. I got him on 5.25 between 10/03 and 10/05.

You don't have to. What treats are you giving him?

- I give him the Orijen Grain-free Freeze Dried. I give him one if I got the blood sample in one go, and two at most if I have to try again haha.

What stage CKD is he at?

Many vets jump to "prescription" food even when there's really no need – both with diabetes and CKD. The only time a cat might need K/D is when they're in stage 4 or end stage CKD. Otherwise, you want to feed foods that are both low carb (for the diabetes) and low phosphorus (for the CKD). It used to be thought that a low protein diet is beneficial for cats with kidney disease but newer research shows that it's much more important to restrict phosphorus. That restricting protein at low levels of CKD just leads to muscle wasting.

Look into canned foods by Weruva. They have a large variety of flavours that are both low carb and low phosphorus. And they put their nutritional information on their website for every single one!
Look for foods with carbs under 10% and the dry matter for phosphorus under 250mg. Treating the diabetes will in turn help the kidney disease by reducing the strain on the kidneys that diabetes causes.

- His last blood work was on 07/31 and Creatinine came out as 2 (previously 2.6 in March). So I would say he is a stage 2.
- That makes me feel much better! I am currently feeding him food with 0.9% / 1.1% phos. I will try to figure out the number on dmb.
- I will check out Weruva too. I tried with him many years ago and he didn't like it. But these days he craves for any food (which I am happy about, better than not eating).


And I know I sound like broken record as this point but thank you for your timely and detailed response. While I have been lurking and posting on this forum, this is really the start of us following TR method tightly with proper home testing. So thank you for making this new start easier for us!