10/17 Crushy amps 405 +2 385 higher low carb food?

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Michele M

Michele M

Member Since 2013
previous http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=106436&p=1129206#p1129206

Its kind of bugging me how he's either on a bounce and in high numbers or quickly dipping low and getting a reduction. There is not a lot of in between. I really want him to hang out in reasonable healing numbers longer than the split second it takes to earn a reduction. (he's had a few blue streaks but those are few and far between)

When will his cycle flatten out??

Im mulling over the idea of trying a higher low carb food (8-10%) to help flatten out his curve. I dont really know how to go about doing that though. Do I just start him on it and see what happens?? Im guessing Ill end up slowly increasing his insulin until it flattens out?

I need to wait a little while before I try that anyway because I just gave him a new food this morning, Nature's Variety Instinct canned Beef. It has no chicken at all (Im testing the theory that he may have some kind of allergy/reaction to Chicken) Im not seeing any difference at all so far but Ill give it a little more time. (this change in food was from a 5% carb (Wellness No Grain Core Beef Lamb Venison(which contains chicken)) to a 3% carb....the 3% carb (Nature's Variety) was the only one I could find that had no chicken at all and still a reasonably lowish phosphorus level)

just fyi When I switched him from the 1% carb raw food I had been feeding him for 10 years, to the %5 carb Wellness food on 9/22 I saw a little bit of a difference in his numbers (an improvement but not huge) but he acted not as starving. He seemed so much more satiated and calm. Thats the main reason I kept him on it.

Any thoughts on the higher low carb food to flatten out his curve?

(He seems pretty good today. He did a happy crap dash up and back down the stairs and then preened in a sunbeam for a while. Seems to LOVE the new food too) He's still drinking a lot but apparently the high numbers are bothering me more than him.
 
I don't know if this is relevant, but maybe you want to consider the approach I'm going to take now of not giving a reduction the moment it's earned, but waiting until the cat goes between 40-50 on three separate days before giving a reduction.
 
I was going to try that if the last reduction I just did does not take. I wanted to give it one more time.

The first reduction he earned on 10/8 was followed quickly by another one on 10/10 (I lowered the dose between the two). Someone suggested that the one on 10/10 was actually still from the 2 units he was on on 10/8. IE the storage shed had not yet drained to 1.75 units. So when I reduced on 10/10 again to 1.5 I really should have kept it at 1.75. That seemed to pan out because the 1.5 didnt do much of anything BUT when I moved him back to 1.75 he earned a reduction again.

so I was going to see how 1.5 units goes (again) and if I have to go back to 1.75 I was going wait until he goes between 40 and 50 more than once before reducing.

I dont know though I never really got the go ahead for that plan from any of the more experienced people. I AM a compulsive tester so I think it would be ok, but your kitty has been on insulin a little longer than mine....
 
this is true...options are good

Problem is I want to try everything at once :roll:

my patience pants are annoying and itchy today.......
 
Michelle, I know how you feel...China's the champ at failing reductions!! She's failed every one we've ever tried, and then when we go back up, she dives into the 20's or 30's...makes it hard to know what to do.

I finally did the 3 separate days where she got to 40-50's too. It's worth a try if Crushy fails this one again (like China is trying to fail hers today)

The other option is to go back to 1.75 (if this reduction fails) and waste 1 drop before shooting. Screw the plunger until a drop forms at the tip and rolls down. If that ends up taking Crushy too low again, drop it 2 drops. The "perfect dose" may be somewhere in between 1.75 and 1.50

Edited to delete information
 
Those are good ideas Chris, thanks.

I have my caliper and handy dandy magnifying glass goggles so I should be able to to this

and when you find that magic dose the cycles flatten out a bit right?? ideally?? the more time he spends in good numbers the less reactive his liver gets?
 
and when you find that magic dose the cycles flatten out a bit right?? ideally?? the more time he spends in good numbers the less reactive his liver gets?
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That's the idea, but so far, we haven't found a copy of the protocol translated into a language our kitties understand ..and their lack of thumbs make it hard for them to turn the pages :lol:

Seriously though, yes, as their liver gets more used to being in "normal" numbers, the bounces should get lower and clear faster...but the one rule I heard over and over when we were first here was "Cats bounce...until they don't"

China used to bounce into the 400's and take the full 72 hours to clear them...Now she only bounces into the 200's and usually clears them in one or two cycles
 
Chris & China said:
yes, as their liver gets more used to being in "normal" numbers, the bounces should get lower and clear faster...but the one rule I heard over and over when we were first here was "Cats bounce...until they don't"
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Im gonna have to break out my bean-to-kitty decoder ring and explain this to little Crushy

and put on my patience pants....YET again

thanks!
 
If you want to be more aggressive, if Crushy drops into the upper 30's or low 40's again, you can try shaving the dose instead of taking the full reduction .
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I would discourage you from using this approach. Here's my reasoning.
  • Crushy is newly diagnosed. Bouncing is a part of the process. You need to give Crushy's liver and pancreas enough time to recover and get reacquainted with normal range numbers. This takes time.
  • If you are concerned with reductions holding, the next step would be to wait until Crushy drops into the 40s on 3 occasions before reducing. (I still think you need to give the version of TR we use here a little more time but the modification used on the German board -- 3 drops into the 40s -- would be a bit more aggressive.)
  • A drop into the 30s and shaving the dose is VERY, VERY aggressive. The TR protocol is, by it's very nature, an aggressive approach to dosing and diabetes management. Shaving the dose on top of a drop like Chris described is exceptionally aggressive and potentially dangerous. IMHO, 2 months on insulin doesn't give you sufficient data to know with any degree of certainty if Crushy's numbers will plummet and you will end up struggling to get them out of the basement. This is not a strategy I would recommend.

That's my 2 cents.
 
I do agree with you Sienne...I would hope she'd try the other options first as well as just giving it more time.

The hardest part of this dance is the waiting. We all want our kitties to be cured "yesterday", but it just doesn't work that way.

If you look at China's spreadsheet Michele, you'll see that until about 2 months ago, we were having lots of problems too. Then one day it just seemed to "click" and although nowhere near going OTJ, she's been in those pancreas healing numbers more and more often.

China's nadir also seemed to skip around a lot..One day it'd be at +5, the next it'd be at +10. I'm sure at some point, you'll also hit a dose that "clicks" with Crushy, and you'll start to see more consistent numbers too.

Those patience pants do get tight, don't they?
 
Sienne and Gabby said:
  • A drop into the 30s and shaving the dose is VERY, VERY aggressive. The TR protocol is, by it's very nature, an aggressive approach to dosing and diabetes management. Shaving the dose on top of a drop like Chris described is exceptionally aggressive and potentially dangerous. IMHO, 2 months on insulin doesn't give you sufficient data to know with any degree of certainty if Crushy's numbers will plummet and you will end up struggling to get them out of the basement. This is not a strategy I would recommend.
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chris, i realize you must have learned this option elsewhere... i hope it wasn't in this group. :mrgreen:

in the interest of safety for all, i'd like to expand on sienne's comment above...

shaving the dose after a drop into the 30s is defintely a very, very aggressive approach used by a very few experienced caregivers who have accumulated years and years of data, who know their cat's response to the insulin used, who have a strategic and well thought out feeding plan in place, and "know their cat" inside and out . those caregivers are knowingly taking a calculated risk based on their knowledge and experience with their cat.

imho, a suggestion to only shave the dose after a drop into the 30s does not belong in a group where the participants are still learning about their cat's response to insulin as well as the insulin used. in the Lantus TR group we've always suggested a mandatory full reduction (0.25u) if kitty drops into the 30s. to do otherwise is taking an unnecessary risk with your cat and can be downright dangerous.

just my thoughts.
let's keep our kitties safe...
 
Thanks Sienne,

I think I want to see him "not hold a dose" more than once before I try this anyway. Im not convinced his drop below 50 on 10/10 and then having to go back to that dose was "not holding the dose" as much as it was having the storage shed from the previous dose on 10/8 not completely drained on 10/10. So I should have given that dose (1.75 u) more time on 10/10 or shaved the dose according to the below quote, right? (am I making sense? this is hard to explain)

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
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The part In bold in the above quote is different than what Chris suggested, correct? (or was it the "drop into the 30s" part that was the distinction?)

Its really good to know there are options out there but I was feeling a little nervous about trying that approach just yet, so thanks for the warning

Chris, my patience pants are downright binding! I definitely want him OTJ yesterday
thanks for the encouragement though. Its good to see that China finally "clicked" at one point.
 
You're totally correct, both of you.

Michele, I'm sorry if I mislead you. That IS very aggressive, and should never be done unless you've been testing for a long time and even then, it can be risky.

Crushy's too new to the dance to be trying something like that. Give him time, and he'll get the hang of it.

Again, my apology to Michele and Crushy....first rule is to always be safe.
 
no worries Chris!
Ive actually learned a lot from this discussion and Im just glad that there are options like that if need be in the future!
 
For a newly diagnosed kitty that doesn't hold reductions, as Sienne suggested, you could let him go between 40-50 on three separate days and then take a .25u reduction. Or, you can shave the dose when he drops into the 40s on one occasion. But, as Jill and Sienne said, it is a mandatory .25u reduction for a drop into the 30s or when kitty drops between 40-50 on three separate days.
 
And, I forgot to answer your original question.

Yes..you can feed a higher LOW carb food to flatten the curve. If you feed at specific times, you can bring the nadir up a bit and once the curve is flat, then you can increase the dose.

Manage the curve with food ----> flatten the curve -------> adjust the dose (if necessary).

It looks to me that, sometimes, Crushy likes to take a big drop between +2 and +4. You might want to start frontloading his cycle with a food higher in carbs than 3%. You will need to experiment, but feeding on a schedule, if possible, might help. You might try feeding at PS, +1, +2, +3 and see how it helps him. You might have to adjust it some and feed at PS, +2, +3, +4. Flattening the cycle won't happen overnight....it takes time and patience to find the correct remedy. As an example, I found when Gracie was on lantus, that I needed to feed the biggest portion of her allotted food at PS and +1 and then feed the remaining smaller portions at +2 and +3.
 
Michele, Tigger takes dives too & Sienne advised that I feed at PS, +1, 2, & 3 as Marje suggests. She said count on several weeks for it to take effect. i feed a really low carb, but it did help somewhat. Tigger still dives, especially when he's coming off a bounce (as I mentioned yesterday), so I've learned to test more judiciously when I see those drops.

Your question re. MC is well-timed - thanks - I was thinking about adding some 5-6% into Tigger's regime, too.

One question I would ask about waiting for 3 BG drops below 50 before taking a reduction: If we ignore the 1st drop below 50, do the subsequent drops become more insistent (lower & harder to get back up). I'd want some informed feedback from experienced members before I took that route - just so I'd know what to expect. I know Crushy came up pretty quickly for you, but sometimes it can be a struggle to get them to stay up. Just MHO.
 
this is very interesting!

ok so his feeding schedule now is 1/2 oz 8 times a day at shot time, +3, +6, +9, am and pm. (he has an automatic feeder)

So you would feed at ps +1 +2 +3.....and then nothing until next ps? (except for no carb treats at ear pokes)
Im thinking keep the same 3% carb 1/2 oz at a time at first and see how that goes and possibly add in higher carb or adjust amounts and times later on
Does that sound about right?


and thats a good question about subsequent drops being harder to get up Suzanne! I imagine they would be but Im not sure
 
If you are feeding later in the cycle, you are slowing down the effects of the insulin. It's best for many cats to finish feeding before the nadir (unless, of course, you need the food to control low numbers). If he gets hungry, a little LC snack is fine. I keep boiled chicken breast on hand and if Gracie gets really hungry, she gets a little boiled chicken breast. It can still bring her BG up late in the cycle.

One question I would ask about waiting for 3 BG drops below 50 before taking a reduction: If we ignore the 1st drop below 50, do the subsequent drops become more insistent (lower & harder to get back up). I'd want some informed feedback from experienced members before I took that route - just so I'd know what to expect. I know Crushy came up pretty quickly for you, but sometimes it can be a struggle to get them to stay up.
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On Suzanne's question, I think it's ECID and even may change from dose to dose. Sometimes I find that Gracie's second drop between 40-50 is active enough that I'm feeding alot to keep numbers up so I will go ahead and reduce the dose. But other times, the first two drops come right up; the third may be a little harder. It would seem logical that, as the depot gets fuller and fuller, it might take a bit more food or higher carb to bring the numbers up but logical doesn't always play into it. :-D
 
Marje and Gracie said:
If you are feeding later in the cycle, you are slowing down the effects of the insulin. It's best for many cats to finish feeding before the nadir (unless, of course, you need the food to control low numbers).
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I did not know that! thank you!!!
 
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