12/19 Crushy amps 354 +2 167 switch to Levemir?

[Michele M]

previous http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=110090&p=1162293#p1162293

sorry no condo for a while. Its been busy around here....

he had some pretty good numbers the last couple days but yesterday I shot a 106 in the am and he seemed to go straight down. I wasnt expecting that. I saw it happening and fed him a LOT of food but he still got to 54 at am +2 and then bounced into the stratosphere. He hasnt quite come down yet....

I keep going back and forth about switching to levemir. On one hand the bounces ARE less frequent but there is still quite a bit of up and down and Im just dying for his cycles to flatten out more.

Im thinking (hoping) if his cycles flatten out a bit there might not be these dives into low #s that send him bouncing so high that I have to wait a several cycles till he comes down to earth again.

Should I give Lantus more of a chance? I actually went ahead and bought a levemir pen but I havent used it yet. Right when I decide to make the switch his cycles start looking a teeny bit better and I wait......

 

[Kim & Twice]

Re: 12/19 Crushy amps 354 switch to Levemir?

Hi Michele,

Just wanted to stop in and say hi, since you have a condo handy ;-) Sure wish Crushy would flatten out for you. Fingers crossed it happens soon.
Have a good day and scritches to Crushy!

 

[Michele M]

Re: 12/19 Crushy amps 354 switch to Levemir?

thanks Kim

Catherine I just saw a post from you but it disappeared....I think you might be right. He just dove 200 points from ps to +2 so Im guessing a lower dose might be warranted.

when he was on 1.5 units before and was in pink and yellows the whole time I initially thought it was a bounce but it was not a typical bounce for him (he usually doesnt have nadirs with his bounces) so at some point I decided it was not a bounce and raised the dose back up. Im wondering if it was a bounce now too though.....

 

[Rachel & Chyna (GA)]

No advice from me, I just wanted to say hello and I hope you guys are having a good day! Hoping you see a flat cat soon

 

[Dyana]

I think I would stay with the Lantus a little while longer. He is bouncing, but the bounces are quick. Maybe, he'll start to bounce less soon.

 

[BJM]

Here are some additional thoughts and ideas on bouncing, from Think Tank They are ideas and thoughts, not mandates, nor protocols.

 

[Sienne and Gabby (GA)]

Michele --

I'm not sure you are thinking about dose adjustments the way most of us do. If you are assuming that a drop of 200 points means a dose reduction is warranted, that's not typically what indicates a reduction is needed. If numbers drop below 50, reduce the dose. If you are having to feed a lot of HC to keep the dose from tanking, then a reduction may be indicated.

Gabby is a kitty that loves to dive. I don't reduce her dose if she drops from pink to blue.

When you note that Crushy doesn't have a nadir when bouncing, I don't see that on your SS. There may be times when Crushy is bouncing and it's a flat cycle. That's not unusual.

If you want to give Lev a try, it's fine. It's not a magic bullet, though. Whether you switch to Lev or stick with Lantus, I'd urge you to follow the TR protocol. Reducing a dose when you're not seeing nadirs in a range where you consistently want them to be may result in glucose toxicity developing since there's a strong likelihood that numbers will run higher.

 

[Michele M]

Michele --

I'm not sure you are thinking about dose adjustments the way most of us do. If you are assuming that a drop of 200 points means a dose reduction is warranted, that's not typically what indicates a reduction is needed. If numbers drop below 50, reduce the dose. If you are having to feed a lot of HC to keep the dose from tanking, then a reduction may be indicated.

Yes Sienne, if you had read my SS you would see that I had to feed a lot of HC lately to keep him from going very low. On 12/18 in particular I fed him quite a bit of MC and HC and he still hit 54 very early in the cycle. The next day was the same story. That is why I decided to reduce the dose. he definitely would have gone below 50 if I had not tried to stop the dives with HC.

When you note that Crushy doesn't have a nadir when bouncing, I don't see that on your SS. There may be times when Crushy is bouncing and it's a flat cycle. That's not unusual.

I guess your seeing something different than what I am seeing

If you want to give Lev a try, it's fine. It's not a magic bullet, though. Whether you switch to Lev or stick with Lantus, I'd urge you to follow the TR protocol. Reducing a dose when you're not seeing nadirs in a range where you consistently want them to be may result in glucose toxicity developing since there's a strong likelihood that numbers will run higher.

I am following the TR protocol Sienne, with adjustments because Crushy OBVIOUSLY does not fit the cookie cutter mold that most cats seem to fall into and tweaks to the protocol are definitely warranted. I am well aware of the threat of glucose toxicity. If you can suggest a method that would keep Crushy from taking nose dives into very low numbers then bouncing into the stratosphere I am all ears!

 

[Marje and Gracie]

Michele

I agree with Dyana that I would wait a bit still before switching to lev. It isn't a magic bullet and there are many cats who still bounce on it....including Gracie. She HAS done much better on it and doesn't bounce as high but she still bounces and dives. But if you look at some of the other lev cats like Ann's Tess, Wendy's Neko, and Dyana's JD, you'll see they all still dive and bounce.

I've looked at his SS and I see you have asterisks on when you feed (thank you) but there is nothing that tells me consistently what you feed at those times. It's great that you annotate in the remarks when you feed a higher carb food but I am just not able to tell what you routinely feed.

I know I've mentioned this to you as did Jill and Libby. One of the things that helps diving kitties is to front load the cycle consistently with a lower carb food that works for Crushy. Maybe he needs 8% food as his regular food....maybe you are giving him that but I can't tell if you consistently feed 8% or only when he's dropping. It looks like you are already feeding AMPS, +1, +2, +3 which is super. But what you feed also matters. The goal is to flatten the curve by feeding their normal food at specified times. So perhaps Crushy needs a big helping of a higher LC food at AMPS and +1 on a consistent basis and then maybe smaller amounts at +2 and +3.

I think one of the hardest things for me was experimenting to find out what controlled those early drops for Gracie and it just took some time to figure it out and time for it to work. I don't mean to be redundant and I apologize if I am and you are already doing this but I just can't tell from the SS. If you have the time and would like to take a peek, you can see how I show what % foods Gracie gets and when (remember she is on lev so when I feed her is different than when I fed her on lantus).

 

[Sienne and Gabby (GA)]

If you were shoveling HC on the AM cycle of the 18th and Crushy still dropped to 54, you could consider a dose reduction. The trade off, though, is that the longer a cat spends in green numbers, the more the kitty's body gets used to those numbers and you reduce the potential for a bounce. The drop from your pre-shot to the 50s isn't all that big of a drop -- it warrants attention and you did a great job of handling it. I think I was reacting to your observations about the drop yesterday morning. I wouldn't adjust the dose based on that AM cycle.

If this were me, I would do anything I could to prevent a dose reduction so Crushy spends time in the best numbers possible. This may mean using higher carb food overall or when you see numbers dropping, continue to do what you're doing to keep the cycle as flat as possible. You wouldn't reduce the dose unless Crushy's numbers force you to. Ideally, you want to see blue pre-shots and green mid-cycle numbers. This is what I do with Gabby. If you want to plow through my data, you'll see that Gabby was much bouncier early on. Things have leveled out considerably.

 

[donaleen and Ozy]

We are going to try Levemir because Ozy is finding Lantus injections painful. I am not thrilled about changing but I can't stand hurting him like this. It may help in ways I don't know. And it may not work as well. It might be an expensive change, both moneywise and treatment wise.

Sometimes other people's condos can be so valuable and this one is very instructive to me. I am trying to do some of the things mentioned here and this feeding thing is very helpful. I still feel very clumsy treating Ozy. Yes, I can keep him safe but I certainly haven't finessed how to respond and predict his cycles.

 

[Michele M]

Michele

I agree with Dyana that I would wait a bit still before switching to lev. It isn't a magic bullet and there are many cats who still bounce on it....including Gracie. She HAS done much better on it and doesn't bounce as high but she still bounces and dives. But if you look at some of the other lev cats like Ann's Tess, Wendy's Neko, and Dyana's JD, you'll see they all still dive and bounce.

I've looked at his SS and I see you have asterisks on when you feed (thank you) but there is nothing that tells me consistently what you feed at those times. It's great that you annotate in the remarks when you feed a higher carb food but I am just not able to tell what you routinely feed.

I think you guys are right about giving Lantus more time. I have it in my signature that I feed wellness no grain at PS +1 +2 +3 unless otherwise noted. I didnt put it on the SS because I didnt want to type it out every day.

I know I've mentioned this to you as did Jill and Libby. One of the things that helps diving kitties is to front load the cycle consistently with a lower carb food that works for Crushy. Maybe he needs 8% food as his regular food....maybe you are giving him that but I can't tell if you consistently feed 8% or only when he's dropping. It looks like you are already feeding AMPS, +1, +2, +3 which is super. But what you feed also matters. The goal is to flatten the curve by feeding their normal food at specified times. So perhaps Crushy needs a big helping of a higher LC food at AMPS and +1 on a consistent basis and then maybe smaller amounts at +2 and +3.

His numbers lately have been going down the most between +2 and +3. I noticed if I feed him more at +2 it slows the drops down a bit but I really have to feed a LOT at that time to slow it up. I worry that if I feed more at ps or +1 it will just raise the diving board up higher so the drop is steeper.....I havent tried it yet though. And another thing, he does NOT seem very carb sensitive to me! I know the protocol says to feed a tsp or 2 of HC if #s are too low, but Crushy's BG would laugh at that! when the insulin is really working on him it takes so much more than that!

If you were shoveling HC on the AM cycle of the 18th and Crushy still dropped to 54, you could consider a dose reduction. The trade off, though, is that the longer a cat spends in green numbers, the more the kitty's body gets used to those numbers and you reduce the potential for a bounce.

he stays in green numbers for such a short time though!! Maybe 3 or 4 hours! then he spends many many hours in pink and red because of it. how can his body possibly be getting used to it if he just touches in then he bounces super high for an extended time again and again?

The drop from your pre-shot to the 50s isn't all that big of a drop -- it warrants attention and you did a great job of handling it. I think I was reacting to your observations about the drop yesterday morning. I wouldn't adjust the dose based on that AM cycle.

no it was not that big of a drop from 126 to 50.....but I had never seen him drop like that from a low number. Usually when he has low pre shots he stays fairly steady. And I was definitely shoveling a LOT of food at him to keep it up that day. I had no idea how strong a drop that dive was and there wasnt any room to go lower. Then when he dove 200 pts from ps to +2 the next day I got worried again. And he only leveled out into the low blue #s that day because I fed him 3 full ounces of HC plus another 2 ounces of MC. That was enough to have him surf in blue numbers for quite a few hours yesterday. And the bounce from that was much slower and NOT into the 400s (unless I missed it.) So does it make sense why I dont think staying in green #s right now is such a great idea? just touching green sends him straight into reds and pinks

If this were me, I would do anything I could to prevent a dose reduction so Crushy spends time in the best numbers possible. This may mean using higher carb food overall or when you see numbers dropping, continue to do what you're doing to keep the cycle as flat as possible. You wouldn't reduce the dose unless Crushy's numbers force you to. Ideally, you want to see blue pre-shots and green mid-cycle numbers. This is what I do with Gabby. If you want to plow through my data, you'll see that Gabby was much bouncier early on. Things have leveled out considerably.

I HAVE been using higher carb food when I see him dropping! He likes to eat but the amount of food Im shoveling at him is huge! It worries me because he is already overweight. And yes I would LOVE to see blue pre shot #s and green mid cycle numbers but that seems like a castle in the sky right now!

 

[Marje and Gracie]

Michele

Thanks for clarifying. I did see that in your signature block but Wellness no grain comes in many % carbs. If you are feeding the Complete Health that is grain free, it ranges from 4% to much higher. If you are feeding the Core varieties, they generally range from 5-12%.

If his numbers go low between +2 and +3, you want to have the food on board before he starts the drop. That's the same issue I had with Gracie on lantus; she would onset like a steamroller at +2 so I fed bigger portions at AMPS and +1 so the food was already there when the insulin onset. Today, Crushy likely started his drop from AMPS because he was already much lower by +2. If I have a cycle where I have to feed Gracie more to control the curve, then the next cycle, I feed less so her overall calories for the day try to even out with what she should get so she doesn't gain weight. If she gets hungry the cycle subsequent to the low cycle, I also give her a little boiled chicken breast....low carb and low calories so I can try and keep her overall calories/day about the same.

The other thing is if you are able to spot a high before a break of the bounce or if he's starting to clear his bounce, I'd probably be alert to possible lower numbers.

I know you are doing the very best you can. It's the experimenting that becomes a little frustrating.

 

[Michele M]

Michele

Thanks for clarifying. I did see that in your signature block but Wellness no grain comes in many % carbs. If you are feeding the Complete Health that is grain free, it ranges from 4% to much higher. If you are feeding the Core varieties, they generally range from 5-12%.

ah sorry, its the chicken and beef & chicken varieties of wellness no grain. They are both 4% carb I believe. Ill note that on my signature...

If his numbers go low between +2 and +3, you want to have the food on board before he starts the drop. That's the same issue I had with Gracie on lantus; she would onset like a steamroller at +2 so I fed bigger portions at AMPS and +1 so the food was already there when the insulin onset. Today, Crushy likely started his drop from AMPS because he was already much lower by +2. If I have a cycle where I have to feed Gracie more to control the curve, then the next cycle, I feed less so her overall calories for the day try to even out with what she should get so she doesn't gain weight. If she gets hungry the cycle subsequent to the low cycle, I also give her a little boiled chicken breast....low carb and low calories so I can try and keep her overall calories/day about the same.

Your looking at yesterdays curve but I see your point! (this is actually yesterday's condo. I responded to a post today that I should have put in a new condo) Ill try more/higher LC food at ps and +1....and watch for highs indicating an impending low and feed a bit less when he's on a bounce to offset the extra food during lows. On 12/18 I did just that though. I loaded him up on some higher LC food on PS and +1 and he still went down. Is that something that over time has more effect maybe?

I know you are doing the very best you can. It's the experimenting that becomes a little frustrating.

it really is! thanks though I appreciate your help!

 

[Marje and Gracie]

Oops....yes, I realized I was looking at yesterday's condo and then I posted here but forgot to change what I wrote there when I pasted it here :lol:

As I recall, when Sienne started feeding Gabby to manage the curve, it took a few months to see a result. Same thing with Gracie....it wasn't overnight that she stopped diving. And even on lev, she will still dive but I think that's because she has something else going on.....like the absorption is different.

IMHO, I'd try one of the other WN foods....I like the WN Core turkey and duck which is 5% but I found it packs a little more punch. The more consistent you can be, the better.

 

[Michele M]

interesting...do you think the wellness core beef, venison & lamb would work like the Turkey and Duck? its 5% too. I have some of that but havent been feeding it. Or is there something different about the turkey and duck one?

 

[Marje and Gracie]

It should work, too. Gracie just doesn't like it :lol: :lol: :lol:

 

[Michele M]

Ill give it a shot
Ill also give the turkey and duck one a try too. I noticed the turkey and duck flavor of Wellness Healthy Indulgence pouches packs more of a punch than you'd think for 9% carbs too. It may be something in that particular flavor that does it.

 

[Marje and Gracie]

Could be....I used the packs at first but found that gravy is not effective with Gracie. We got better results from giving her food. The gravy wouldn't work very fast and then all of a sudden, would send her skyrocketing.

 

[Michele M]

at first the turkey and duck pouches with gravy would make him surf really nicely....then he started only eating the gravy and leaving the meaty bits in the dish and it didnt seem to do much at all.

Ill experiment

 

[Marje and Gracie]

Ok. We're having to do it again now because Gracies good mgmt food started making her vomit. So we are reinventing the wheel.....not fun at this stage is I feel your pain ;-)