10/17 Josie- can someone check her SS?

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eccentricfuzzyme

eccentricfuzzyme

Member Since 2011
Ever since I changed Josies dose almost 2 weeks ago her numbers have been all over the place, going up instead of down some afternoons, etc. No rythm or reason to the pattern.
I dont know what I should do, it makes no sense to me.
 
Just curious why did you keep raising her dose when you saw green on 1.5u...It looks like the more you raise her dose the worse the numbers become, personally that looks like too much insulin to me. I would reverse course and drop her back to 1u b.i.d. and hold that dose for 3-5 days to let it settle then see where you are after that period of time.

Mel, Maxwell, Musette & The Fur Gang
 
i go by what people on the other lantus board advised. i dont understand dosing at all, so i dont change it without others recommednation.
she has been brought all the way down to 1 unit before, and then worked our way back, and here we are.
she was having bounces before the most recent rise, those werent steady numbers.
 
or do you mean way back when she was first diagnosed?
i was told that since i cant test much or be home with her to watch her or postponse shooting, her numbers and/or the fact her numbers went up then down fast meant it wasnt a good dose.
the vet had her on 4 units, it was the people here who advised to start lower and then raise it.
i dont get any of it. her SS is gobbedly gook to me.
 
It just looks like you were getting much better numbers at 1.5 and from what I can see by her spreadsheet she only got 1u once. With Lantus the dose needs to be held for 3-5 days to settle in. The higher you have raised her dose the more she starts swinging in numbers. Which to me would say the dose is too high and she is in rebound. Like I said I would reduce her back down to 1u for 3-5 days then see where she settles on that dose, I really can't see to keep raising her dose if that only gets her in worse and worse numbers. Unless there is some type of under lying problems like infection or bad teeth etc.

Mel, Maxwell, Musette & The Fur Gang
 
i think some of what you've got going on with the higher dose is just because of the dry food. i know you don't want to change it; i'm just saying that there is a direct relationship between the food that josie's eating and the insulin dose. the cats using lower doses are almost certainly on low carb canned food.

if i were you, i'd go up to 3.25 and continue getting the mid-cycle checks to see how low it's taking her.
 
My Duncan is on Lantus, and that is a HUGE dose change by half IMHO. To go from 1u to 1.5 or 1.5 to 2. That is huge change for a tiny animal like a cat. I follow the tight regulation only about if it is time for an increase or decrease, and the protocol suggests changes by .25 amounts or .5 amounts and that is way too much change for him. I change by .25 or less and see what that does. Lantus is an amazing drug and if it is used sparingly and steadily and changed very slowly can be extremely effective. Slow change is the way to go. Also agreeing that it is too much insulin that you are seeing no rhyme or reason to his curve because it's not a curve it's a sort of crisis reaction to too much insulin.

That being said ECID (every cat is different) and EBID (every bean (human being) is different.) Slower change will give you more consistency and that is what you need to be comfortable leaving him. If you could very slowly sneak it down over the course of several cycles you will see a place where it all kicks in and really starts to work well. The other way would be to stop it, and start over at 1u twice per day and hold yourself to that no matter what for a set number of cycles to get it out of kitty's system and down to a better level.
 
I have to post one more time seconding Julie and Punkin. When I first came here I had a very similar line in my sig about dry food etc... and when I switched the whole game changed. PLEASE Check out Duncan's SS. His is a great testimony to the good low carb wet food can do.

It's pretty amazing the difference it can make! Just keep thinking about it. Maybe get a few cans of the wet and see if you can just mix for a bit, see if you can get creative and make the switch to all low carb wet at some point. It took me a week to figure out how to make it work in my house, but we did and I could not be happier with the results.
 
My Latte had a lot of issues affecting her BG's.

She also ate a diet of about 50%+ dry food because it was difficult to get her to eat ANYTHING (even dry most of the time).
I spent a good deal of time trying to figure out the correlation between her BG's and the dry. I noticed (and you can look at her ss...not something I can do now that she is gone), is that she would spike within a few hours after the dry. It would take a few hours beyond that for her to drop. For example: If she had a lower amps/pmps than normal or I felt comfy shooting, I would look at her kibble bowl (or remember hearing her eat in the midst of the night). If I knew she had just eaten the kibble, I was fine with shooting. The kibble would bring her up in a few hrs despite the insulin. If the last time she ate was hours ago, I knew she would probably drop from the kibble food spike and I would often hold off or shoot a lower dose. If this sounds confusing...it is. Kibble adds confusion, uncertainty, and unreliability. Been there, done that...for my own reasons. I understand for whatever reason that is the way you need to go for now. No judgment. Just realize it most likely going to make Josie's numbers a little more all over the board than other kitties.

I noticed you just started dosing quarter units. this is good! The half unit jumps up/down, which you were doing, can cause the right dose to be missed. Sometimes reducing/increasing it by just a drop can make a world of difference.

You said you were confused by the dosing. It IS confusing. What part(s) are confusing you? Maybe posting both in this group and the other lantus about your confusion will bring about some clarity.
 
Last night she was 310 pmps, this morning she is 193 amps. i dont know how anyone is supposed to "properly" care for a diabetic cat when they cant be home with them most of the time.
So should I go up or down? Or stay the same?
I dont know how to know what is a bounce and what is real.
I dont understand why she has been going up instead of down midday.
I dont understand how she can have totally different results at the same dose, weeks apart.
The very put her on 3 units, then 2 weeks later (i hadnt been home testing then) raised it to 4 after an in office curve. then i found this place.
 
i have to leave in a few minutes, so i am going to have to shoot now. i guess i will do 3 units as normal , and then hopefully will have a better idea what is advised to switch to for tonights shot.
thanks
 
This is from a sticky in the Lantus tight protocol group. (There are more stickies over there for Lantus)
A cycle is 12 hours, or the time from one shot to the next. I wouldn't change food or anything diet-wise unless you can be there to monitor. Nadir is the lowest point in the cycle, usually somewhere around +4 - +6 hours from the time of the shot, but every cat is different with this.

Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


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.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

So - reducing the dose suggested here looks at the nadir for the indication to lower it, but you could start lowing it right away. High BG is not great for kitty, but it's not an instant death thing like hypo is. Looks like she's been at 3u for many cycles. You could sneak it back by .25 or go for a step of .5. Either one I would hold it for 3 days or 6 cycles unless something goes really haywire. And keep repeating that until you find a place where it starts to kick in and have a nice curve. All that being said, I don't know if you'll get a nice curve you can see unless kitty is on wet. Duncan's numbers are a LOT more predictable now that I switched to wet. There are automatic feeders out there, and people just mix the later meals with water and freeze so they keep for the whole day. There's a nice one from Petsmart that has a dish that rotates and can hold 5 meals. Maybe someone else can post that link?
 
Angela:

I have to disagree very much with taking her back to 1u and starting over. That was in October. What worked then may not work now and I know this with my own cat.

I agree that the dry food is going to continue to be a problem. Carolyn is one of our really experienced members and she has
some very good points about the dry food. I'd have to look back at your condos but I don't remember us suggesting that you bump up by .5u when Josie was getting blue nadirs.

I am concerned that she has very erratic cycles such as 12/9 pm cycle where she dropped 300 mg/dl in 7 hours. I understand your limitations but with that kind of drop, we have no idea how much she might
actually be getting into lower numbers and then bouncing back up. You did no mid-cycle testing on 12/10, 12/11, or 12/12 at night. Look at 12/14 pm cycle....what if she dropped low that night? You wouldn't know
and you could be dealing with a bounce back up in the subsequent cycles.

I know we are sounding like broken records and I'm sorry about that. You have to decide if Josie or your social commitments are more important. I know it's difficult and you are young; but it's very hard
to help you when we really do not know what is going on. It is possible you missed her fitting dose somewhere in those big jumps but I am not comfortable advising you to go up or down until you can
help us see what is going on with her numbers; she is definitely capable of dropping at mid cycle.
 
What about tracking food intake?
I keep thinking that you may be getting high numbers that are affected by food when you test, so part of the 310 may be food, and the morning 193 is a more true number that is not food influenced.... what do you think?

you can test it out too.
In the morn, measure out 1cup of the dry food, and mark the time on your ss. The next time you test, measure how much food is left at that test. If food runs out, mark when you put down another cup of food. Do you leave food out overnite? Make a note if food is gone in the morn when you test.

A food diary along with your testing numbers may show you the reason for the ups and downs, and you will know that you are doing a perfectly fine job of taking care of Josie!

Don't worry about lots of testing. lots of people are away and work so they can't test during work either! just do what you can with amps pmps and bedtime on most days, then on a free day, you can do a curve.

Try tracking food and the test numbers and you may see that the little spikes are a few hrs after she ate some food, so it's ok.
 
This isnt about my damn social life. i am not out partying or something.
i am josies only caregiver. how in the world people with jobs and families to care for, not to mention thier own health and, god forbid, sleep needs can get mid cycle tests regularily.
i am going to have to look into giving her up. this is insane. she is draining every last cent i have, and all my "free" time.
i cannot put a cat over a human. i love her, but she is a cat.
 
I wish you would give it all a chance to sink in and just make small changes at a time and see what you can do?
I believe there is a board or a link here to put a diabetic cat up for adoption if that is what you choose to do.

I think just about everyone here was very stressed out and overwhelmed when the kitties were first diagnosed. Maybe just make the changes you can and see what you can add in later? We've all been there. I'm still stressed out most of the time. :)
 
eccentricfuzzyme said:
This isnt about my damn social life. i am not out partying or something.
i am josies only caregiver. how in the world people with jobs and families to care for, not to mention thier own health and, god forbid, sleep needs can get mid cycle tests regularily.
i am going to have to look into giving her up. this is insane. she is draining every last cent i have, and all my "free" time.
i cannot put a cat over a human. i love her, but she is a cat.
Click to expand...

Goodness! I sure don't have a social life, and I would never mention such a thing, so I hope any comments like that you can disregard. I know that if you did not care about Josie, you would not be here, and that's good enough for me!

It's OK if you want to stick with the dry EVO as that's a very good dry food, and there are some cats who would refuse to eat if wet was forced on them ... I know, I have one! So stick with what you are feeding and we can work around it, OK? Sure it may help to switch to wet food, and there may even be a chance of needing no insulin that route, but we can work with what is fitting for you.

You mentioned expenses... OK, there are many of us who are really short in the cash dept but there are ways to save...If you can mention what things are most expensive that need lowering, I bet there are people who may have some suggestions. Lots of things people pay money for the vet to do but it can be done at home by you!

This is the Relaxed forum, and its purpose is to offer alternatives that can help our kitties when the rigid format just doesn't fit what we are capable of doing.

I want to touch on the testing part. To use an example that's very general of a busy working person...
Monday to Friday is work from 9 to 5. you can test the cat and shoot at amps(7am?), then go to work, come home, and test at pmps(7pm?) and have your evening just fine. Just before you go to sleep, get a before-bed test.
So on a work day, test 3 times... total 15strips.
One the weekend, there is no reason you can't do the very same thing.... 3 tests a day, so that's another 6 strips.
If possible, maybe on one cycle, like Sat or Sun, test amps, +3 +6 +9 pmps, and bedtime. That curve would be plenty to give you a decent indication of how the insulin is working.

So how does that sound? Sure it's not perfect but we just do what we can, OK?
I can appreciate the expense of strips as I am in Toronto so like you, we can't go with the Relion meter that costs $9 or the test strips that cost 1/3 of ours in Canada. It ain't easy but let's see what we can do to help you keep your Josie with you.
 
Hi Angela (right?),
I spent a good amount of time this a.m. reading some of your earlier posts when you arrived here at FDMB, thought a lot about you and Josie today, and now want to sit down to share some thoughts with you. I hope that is ok.

First to answer your protocol questions:
I dont know how to know what is a bounce and what is real.
Click to expand...
It is hard to tell at times with most cats, especially in the beginning phases of treatment. Most likely when you see an unusually high number, or numbers increasing instead of decreasing after giving insulin you might assume it is a bounce. In Josie's case it could be a bounce OR a spike from the kibble. A bounce can last up to 72hrs (3 cycles), but not always. Sometimes it may just be one cycle. I know this does not answer your question regarding whether she is bouncing or just high. I don't think anyone can know for sure under the circumstances.

One example of what 'could' be a bounce in Josie's case is Dec 11th-14th. On the 11th she went under 200. She stayed in the high 200's and into the 300's for the next 3cycles. You woke up on the 14th to a blue amps. That 'could' have been her breaking through the bounce.

I dont understand why she has been going up instead of down midday.
Click to expand...
Assuming you feed after you test, the kibble is possibly bringing her numbers up around +3 to +6. For some cats it will stay in their system longer than others. This would account for higher mid day readings. The other possibility is that she is going into the 100's (or lower) over night and bouncing the next cycle, only to clear it in time for the evening cycle.

I dont understand how she can have totally different results at the same dose, weeks apart.
Click to expand...
Body chemistry changes, diet, mood/stress, other illness or pain. Us humans may think nothing has changed in their world because we have not changed it for them (ie/schedule, food type, attention, etc). They are still living beings. They have ever changing needs, just like us.

I hope my responses help a little.

From reading your other posts, I understand you are Josie's only caretaker. I was the only one who cared for Latte. She had multiple health issues for years, often requiring special feedings, monitoring, and other medications aside from the insulin. I COMPLETELY understand how difficult it is. When we got the FD diagnosis I thought for sure it was the end. I could do no more. I was stretched soooo thin. I had nothing left to give ...emotionally, physically, financially. I had that feeling often the last 9 months of her life. I worked multiple jobs and still did not have money. At times I used the food shelf so I would have money for some of her medical supplies. She has been gone about 1.5yrs now and I still feel like Im trying to get MY life back. Yet, I have absolutely no regrets. I would do it all again (for HER) in a heartbeat. She showed me how much strength I really did have. I want you to know I am not sharing this with expectations that you should/shouldnt put similar dedication into Josie. I am sharing to let you know I get it. I understand what it is like to feel so overwhelmed and well...helpless at times. We all have a threshold for stress, that is for sure!

I know you love Josie. You have had her 14yrs? You took her to the vet when something was wrong. You found this board. You are testing and asking questions. I can also tell you are worried about her. I really do believe you want to help her.

It is clear as a bell that you are not interested in changing Josie's food.

Finances are tough. UG! Do I ever get that one! Some of what you can do for Josie is limited due to funds, am I correct?

You wanted to take the start low/go slow approach because you felt you could not test as much as necessary in order to follow a tighter protocol.

You are feeling extremely frustrated due to the unreliability of her BG numbers.

Here are my thoughts:

If the financial constraints could be lifted a bit, would you be less stressed about your situation? nbbbbb<----- (sorry foster kitty forcing herself on my lap and wanted to contribute :lol: ). There are resources out there to help you. Would you like some information on those options?

You do not have to do daily curves by any means. Would you be able to do 1-2 curves each month? This would mean testing every 3-4hrs, 2 days out of the month. You could do one daytime (movie day!) and one evening (call it a kitty slumber party! :mrgreen: ). This would help give YOU a better idea as to when you should increase or lower the dose. It may be a time commitment, but in the end take up less time because you are not consumed with trying to figure things out and being stressed.

Marking on the ss about food as Gayle suggested is a great idea! That is how I learned when Latte was spiking from food and when it would end. I know you have multiple cats, so it may make it more challenging. Gayle has multiple cats too...maybe she can offer more ways to go about it so you know you are monitoring Josie's food and not the other kitties, too?

I did notice Josie has possibly been sitting right around renal threshold for a while now. I wonder if it is possible Josie's UTI is recurring? When a kitty hits renal threshold, sugar is dumped into the urine. Sugar+urinary tract = increased possibilities of infection. Infections can cause BG's to be high or all over the board.

Finally, I am wondering what your main goals are with Josie. We all want a healthy, happy kitty. Im pretty sure I am safe in assuming this! Are you hoping for remission? Are you ok with giving insulin the rest of her life? Is there a certain BG range you would like to see her in on a regular basis? Is there a better way the members of FDMB help you with your goals?

My greatest hope for you is that you can go back to enjoying Josie. I bet you two have exchanged a great deal of love over the last 14yrs. Give that cutie a kiss on the head for me, will ya?
 
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